Punctate Inner Choroidopathy

Abstract

To describe the clinical features and outcomes of a large group of patients with a spectrum of clinical appearances and diagnosed as having punctate inner choroidopathy (PIC).Methods: In a retrospective consecutive case series, patients seen during a 16-year period at Moorfields Eye Hospital who were diagnosed as having PIC and had a minimum of 12 months' follow-up were included. Patients were classified as having typical PIC or atypical PIC (larger, presumed ocular histoplasmosis syndrome-like lesions). Main outcome measures included development of choroidal neovascularization, development of new PIC lesions, and final visual acuity.Results: A total of 136 patients (271 eyes) were included. The average age was 32 years, 126 patients (93%) were female, and the mean refraction was −4.6 diopters. The overall mean follow-up was 6.2 years. Among 63 normal fellow eyes, 56 (88%) remained unchanged, 3 (5%) de-veloped PIC lesions, and 4 (6%) developed choroidal neovascularization. Eyes with PIC lesions remained unchanged in 49 of 74 cases (66%), with 9 (12%) developing new PIC lesions and 16 (22%) developing choroidal neovascular membrane. In eyes with choroidal neovascularization, the mean logMAR visual acuity was 0.63 at study entry, 0.63 at 12 months, 0.61 at 2 years, and 0.71 at final review (mean, 6.1 years). Overall, 40 eyes with PIC-related choroidal neovascular membrane (26%) had final visual acuity less than 6/60. No differences were observed between typical and atypical PIC eyes in any of the outcome measures or in any of the subgroup analyses.Conclusions: Punctate inner choroidopathy-related choroidal neovascularization was not visually benign. No differences were observed between eyes with typical and atypical choroidal lesions, supporting the notion that they represent a spectrum of a single disease, PIC.

Characterization of macular lesions in punctate inner choroidopathy with spectral domain optical coherence tomography

“…No significant differences in demographics and clinical outcomes were identified between the two groups. They reported that presence of PIC lesions in fellow eyes of patients with unilateral CNV was a risk factor for development of CNV in the fellow eyes as well [14], hence emphasizing the importance of immediately identifying and treating any recurrence in disease activity. Previously, we have shown that the employment of IMT such as mycophenolate mofetil may help to decrease the frequency of attacks in recurrent PIC disease [4].…”

Clinical applications of fundus autofluorescence in retinal disease

“…This disease tends to occur in young, myopic women and is associated with the development of choroidal neovascularization and subsequent vision loss [174]. …”

A 39-year-old woman with unilateral metamorphosias

“…7,[14][15][16] Essex et al, 2 in the largest series of patients diagnosed with PIC, reported a total of 153 eyes of 117 patients with PIC-related choroidal neovascular membranes; 26% of those eyes had a final visual acuity of less than 1/10. The final outcome was similar in all groups with choroidal neovascular membrane, regardless of the treatment; however, in this series none of the patients were treated with anti-VEGF agents.…”

“…2 The symptoms are usually unilateral, but most patients show bilateral fundus involvement. 2,3 PIC is characterized by multifocal choroidal lesions (yellow-white lesions of the inner choroid and retinal pigment epithelium of approximately 100-300 μm in size), usually distributed throughout the posterior pole but sparing the peripapillary region. 2,4 There are no other signs of ocular inflammation elsewhere in the eye.…”

“…2,3 PIC is characterized by multifocal choroidal lesions (yellow-white lesions of the inner choroid and retinal pigment epithelium of approximately 100-300 μm in size), usually distributed throughout the posterior pole but sparing the peripapillary region. 2,4 There are no other signs of ocular inflammation elsewhere in the eye. Visual prognosis is generally good since the lesions usually evolve into atrophic scars; however, choroidal neovascularization may develop in 17% to 40% of patients, potentially threatening central vision if untreated.…”