Research progress in punctate inner choroidopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Punctate inner choroidopathy(PIC)is an infrequent idiopathic chorioretinopathy, frequently affecting young myopic women. There are multiple, small, round, yellow-white or gray punctate lesions in the retinal pigment epithelium and the choroidal lining, in the absence of anterior ocular segment or the vitreous body inflammation. In general, most patients have good prognosis and a few patients will be caused severe vision loss if complicated by choroidal neovascularization(CNV)and subretinal fibrosis. This article reviews the etiology, pathogensis, clinical manifestations, diagnosis and differential diagnosis and treatment of PIC.

A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome

PURPOSE: To report a delayed onset of multiple evanescent white dot syndrome in a patient with punctate inner choroidopathy. CASE SUMMARY: A 23-year-old female complained about sudden visual loss in the right eye. Best-corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. In fundus examination and optical coherence tomographic images, subfoveal choroidal neovascularization (CNV) with hemorrhage was observed in the right eye, accompanied by multiple lesions of atrophic pigmentation on the posterior pole in both eyes. We diagnosed the patient as punctate inner choroidopathy (PIC) and CNV in the right eye, and treated her using three monthly intravitreal injections of bevacizumab (Avastin®, Roche, Basel, Switzerland; 1.25 mg/0.05 mL). The CNV regressed and the BCVA improved to 20/20. Two years later, she complained of visual impairment in her left eye. The BCVA was 20/40. Fundus photography revealed numerous small white dots around the posterior pole and optic disc. Disruption of the photoreceptor layer was seen in optical coherence tomography images. Small white dots were observed as multiple hyperfluorescent dots in fluorescein angiography and hypofluorescent spots in indocyanine green angiography. An enlarged blind spot was observed in the visual field. We diagnosed her as multiple evanescent white dot syndrome (MEWDS). One month after systemic steroid treatment, the multiple white dots disappeared and the BCVA improved to 20/20. CONCLUSIONS: We determined that PIC and MEWDS, which belong to the white dot syndrome, could occur in a patient at different times.

Recurrence of Punctate Inner Choroidopathy with an Intravitreal Dexamethasone Implant

PURPOSE: To report a case of punctate inner choroidopathy (PIC) treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment. CASE SUMMARY: A 23-year-old highly myopic female who presented with PIC in her right eye was treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment including facial edema and sleep disturbances. Three months after the implant she complained of severe acute visual disturbances in her right eye. Her visual acuity was classified as hand movement. Choroidal neovascularization (CNV) was observed on optical coherence tomography and indocyanine green angiography revealed more multiple hypofluorescent lesions compared to the initial visit. Six months after the systemic steroid and intravitreal bevacizumab injection treatments, visual acuity in right eye improved and the CNV disappeared. CONCLUSIONS: This report describes a case of PIC after, treatment with an intravitreal dexamethasone implant due to the side effects of systemic steroid treatment, which recurred with complications.

Unilateral Punctate inner choroidopathy with choroidal neovascular membrane in a young male.

Punctate inner choroidopathy (PIC), first described by Watzke et al., in 1984, is a disease of young, relatively healthy, myopic women characterized by small yellow‑white lesions of the inner choroid and retinal pigment epithelium (RPE).[1] The chorioretinal lesions seen in PIC tend to be small and acutely no larger than 500 μm. Acute lesions heals to atrophic scars and develop more pigmentation with time. Choroidal neovascular membranes (CNVM) develops in more than half of these individuals. We describe a case of PIC occurring in a young adult male with CNVM. The clinical characteristics, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) findings are described.

Flare up of choroiditis and choroidal neovasculazation associated with punctate inner choroidopathy during early pregnancy.

A 28-year-old, healthy female, who had a recent repeated history of miscarriage, presented with bilateral choroidal neovascular membranes (CNVM), for which she received photodynamic therapy with three doses of lucentis, at intervals of one month each, to which she responded. After five months, the patient again presented with complaints of diminution of vision since 15 days. She had a history of miscarriage two days before presenting to our clinic. CNVM was scarred at this time and the fundus picture showed multiple small punctate spots around the fovea at the level of the choroid, which showed early hyperfluroscence on fundus fluorescein angiography, suggestive of punctate inner choroidopathy. She was advised systemic steroids, to which she responded dramatically.

Clinical Features of Punctate Inner Choroidopathy in Korea

PURPOSE: To characterize the clinical presentation and visual prognosis of punctate inner choroidopathy in Korean patients. METHODS: Eleven patients (seventeen eyes) with punctate inner choroidopathy (PIC) and four (six eyes) with multifocal choroiditis with panuveitis (MCP) were analyzed retrospectively. RESULTS: The mean age of the PIC patients was 32.2 +/- 9.3 years and the mean refractive error was -4.79 +/- 3.18 diopters. In all PIC eyes, fundus photographs showed multiple yellowish white punctate lesions and punched-out scars at the level of the inner retina and choroid. There was no significant difference between the mean initial visual acuity (0.67 +/- 0.40) and the mean final visual acuity (0.56 +/- 0.41). The major cause of visual deterioration was choroidal neovascularization (CNV) which developed in 4 eyes. In PIC, the lesions were located in the more posterior retina and the incidence of CNV was higher than in MCP. CONCLUSIONS: PIC affects young women with moderate myopia and shows the characteristic chorioretinal lesion. Although the eye with PIC usually maintains stable vision after initial attack, CNV may cause complications and significant visual loss.

Punctate Inner Choroidopathy

Punctate inner choroidopathy is a clinical disorder of unknown etiology that affects the retinal pigment epithelium and inner choroid resulting in visual loss. Punctate inner choroidopathy is characterized by multiple tiny punctate yellowish-white lesions in the deep retina of posterior pole. There is often an associated serous retinal detachment and subretinal neovascular membrane. The lesions are characterized by small punctate hyperfluorescent in the early phase and leak or stain in the late phase by fluorescein angiography. The authors experienced a case of suspected punctate inner choroidopathy associated with decreased visual acuity in a 24 year-old female and reviewed the available literatures regrading the disease.