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Kalogeropoulos D, Rahman N, Afshar F, Hall N, Lotery AJ. Punctate inner choroidopathy: A review of the current diagnostic and therapeutic approaches. Prog Retin Eye Res 2024; 99:101235. [PMID: 38181975 DOI: 10.1016/j.preteyeres.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
Punctate inner choroidopathy (PIC) is an uncommon idiopathic inflammatory condition characterized by multifocal chorioretinopathy that primarily affects young adults, with a predilection for myopic females. Clinically, it manifests as small, yellowish-white lesions in the inner choroid and outer retina, often associated with inflammatory changes. Accurate diagnosis remains a challenge due to its resemblance to other posterior uveitic entities, necessitating an astute clinical eye and advanced imaging techniques for differentiation. Multimodal imaging plays a crucial role by offering valuable insights, as it enables the visualization of various abnormalities related to uveitis. The pathogenesis of PIC is still a subject of debate, with a complex interplay of genetic, immunological, and environmental factors proposed. Managing PIC presents multiple challenges for clinicians. Firstly, variable disease severity within and among patients requires diverse treatments, from observation to aggressive immunosuppression and/or anti-VEGF therapy. Secondly, treatment must distinguish between primary causes of vision loss. New or worsening PIC lesions suggest active inflammation, while new neovascular membranes may indicate secondary neovascular processes. Thirdly, deciding on maintenance therapy is complex, balancing PIC prognosis variability against immunosuppression risks. Some patients have long periods of inactivity and remission, while others face sudden, vision-threatening episodes during quiescent phases. Through a systematic review of the literature, this paper sheds light on the current understanding of PIC, its challenges, and the prospects for future research. By synthesizing existing knowledge, it aims to aid clinicians in accurate diagnosis and guide treatment decisions for improved visual outcomes in individuals affected by PIC.
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Affiliation(s)
| | - Najiha Rahman
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Farid Afshar
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Nigel Hall
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Andrew John Lotery
- Southampton Eye Unit, University Hospital Southampton, Southampton, United Kingdom; Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
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Ramtohul P, Cabral D, Cicinelli MV, Freund KB. RECURRENCE OF ACUTE RETINOPATHY IN PSEUDOXANTHOMA ELASTICUM. Retin Cases Brief Rep 2024; 18:159-163. [PMID: 36730817 DOI: 10.1097/icb.0000000000001363] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/23/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To report a case of recurrent acute retinopathy associated with pseudoxanthoma elasticum and to propose a reappraisal of this entity based on multimodal imaging analysis. METHODS Retrospective case report. High-resolution optical coherence tomography (high-res OCT), ultra-widefield imaging, and widefield swept-source OCT angiography and en face OCT were performed. RESULTS A man in his 40s diagnosed with pseudoxanthoma elasticum and angioid streaks presented with two distinct episodes of acute retinopathy in his right eye during a one-year follow-up period. Acute retinopathy was characterized by rapid vision loss. High-res OCT showed multifocal hyperreflective lesions splitting the retinal pigment epithelium/Bruch membrane complex and associated with focal choroidal thickening. After the first episode, OCT angiography confirmed the development of macular neovascularization at the site of a previous inflammatory lesion. During the second episode, multimodal images showed findings consistent with epiphenomenon multiple evanescent white dot syndrome (EpiMEWDS). On en face widefield OCT, acute retinopathy was characterized by multiple hyperreflective spots scattered at the posterior pole. CONCLUSION Recurrence of acute retinopathy can be observed in patients with pseudoxanthoma elasticum and angioid streaks. Multimodal imaging shows that some lesions of pseudoxanthoma elasticum-associated acute retinopathy closely resemble those of punctate inner choroidopathy/idiopathic multifocal choroiditis.
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Affiliation(s)
- Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Diogo Cabral
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, NYU Grossman School of New York, New York, United States
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3
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Zaslavsky K, Park T, Lang Mcinnis R, Mandell M, Lee J, Lee C, Gilbert R, Derzko-Dzulynsky L. Outcomes in PIC-Related CNV: Pooled Analysis of Individual Participant Data. Ocul Immunol Inflamm 2023; 31:1825-1836. [PMID: 36179037 DOI: 10.1080/09273948.2022.2124176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
Choroidal neovascularization (CNV) affects 64-75% of eyes with punctate inner choroidopathy (PIC). Although anti-VEGF agents are considered first-line therapy, there is controversy regarding other modalities, such as immunosuppression. We performed a systematic review of individual participant data (IPD) and generated a dataset of 278 eyes with PIC-related CNV from 45 studies. Forty-two percent presented with moderate visual loss (MVL) or worse. Four different treatment modalities (anti-VEGF, photodynamic therapy, local immunosuppression, and systemic immunosuppression) and most combinations among them were represented. Anti-VEGF injections decreased the likelihood of MVL (Odds Ratio 0.3, p = .027), an effect moderated by presenting visual acuity and patient age. Eyes receiving more than 3 injections were more likely to receive additional therapeutic modalities. Increasing number of modalities was associated with longer follow-up time and did not improve vision. The beneficial effect of anti-VEGF injections persisted when controlling for presenting visual acuity and follow-up time.
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Affiliation(s)
- Kirill Zaslavsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Park
- Department of Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel Lang Mcinnis
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mark Mandell
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jihwan Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Christopher Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Rose Gilbert
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Larissa Derzko-Dzulynsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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4
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Airaldi M, Zicarelli F, Forlani V, Casaluci M, Oldani M, Staurenghi G, Invernizzi A. CORRELATION BETWEEN INFLAMMATORY FOCI REACTIVATION AND ATROPHY GROWTH IN EYES WITH IDIOPATHIC MULTIFOCAL CHOROIDITIS. Retina 2023; 43:472-480. [PMID: 36730577 DOI: 10.1097/iae.0000000000003682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/08/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To correlate the number of inflammatory reactivations in atrophic foci of multifocal choroiditis (MFC) with their growth rate over a 4-year span. METHODS Comparative case series. Optical coherence tomography scans of patients affected by MFC were reviewed to identify reactivations within or at the margin of atrophic MFC foci. The area of selected lesions was semiautomatically delineated on fundus autofluorescence images and recorded at yearly intervals for a total follow-up of 4 years. The main outcome was the difference in annual square-root transformed area growth rate between lesions that reactivated and lesions that did not. RESULTS Sixty-six foci of 30 eyes of 24 patients were included. All MFC foci enlarged over time, but the annual growth rate was more than double in lesions that reactivated compared with those that did not (mean [SD], 0.051 [0.035] vs. 0.021 [0.015] mm/year, P < 0.001), despite starting from comparable baseline areas. For each additional inflammatory reactivation, the annual growth rate increased by more than 20% (+0.009 mm/year, 95% CI [0.006, 0.012], P < 0.001). CONCLUSION Increasing number of reactivations of atrophic foci led to proportional increments in their growth rate, highlighting the need for a tight control of inflammatory relapses in patients affected by MFC.
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Affiliation(s)
- Matteo Airaldi
- Eye Clinic, Department of Biomedical and Clinical Science Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy; Department of Ophthalmology, Scientific Institute Capitanio Hospital, IRCCS Foundation, Istituto Auxologico Italiano, Milan, Italy; and The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, Australia
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5
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Bou Ghanem G, Neri P, Dolz-Marco R, Albini T, Fawzi A. Review for Diagnostics of the Year: Inflammatory Choroidal Neovascularization – Imaging Update. Ocul Immunol Inflamm 2022; 31:819-825. [PMID: 35404739 DOI: 10.1080/09273948.2022.2046793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Inflammatory choroidal neovascularization (iCNV) is a rare complication of uveitis but is a major cause of vision compromise in affected patients. Fluorescein angiography (FA) has been the gold standard for diagnosis. However, it is an invasive modality and when used alone, it might be difficult to distinguish iCNV from inflammatory lesions. Optical coherence tomography (OCT) is a noninvasive and rapid imaging modality that can provide additional features to diagnose iCNV. OCT angiography (OCTA) uses intrinsic motion contrast to visualize flow and is useful to distinguish iCNV from inflammatory lesions. However, its role in evaluating iCNV activity and treatment response is still unclear and more studies are required to reach consensus. In conclusion, the use of data from multimodal imaging is necessary to identify and promptly treat iCNV, thus preserving patient vision.
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Affiliation(s)
- Ghazi Bou Ghanem
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Piergiorgio Neri
- The Eye Department, Cleveland Clinic Abu Dhabi, UAE
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amani Fawzi
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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6
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Hady SK, Xie S, Freund KB, Cunningham ET, Wong CW, Cheung CMG, Kamoi K, Igarashi-Yokoi T, Ali OM, Wasfi EI, Rateb MF, Ohno-Matsui K. PREVALENCE AND CHARACTERISTICS OF MULTIFOCAL CHOROIDITIS/PUNCTATE INNER CHOROIDOPATHY IN PATHOLOGIC MYOPIA EYES WITH PATCHY ATROPHY. Retina 2022; 42:669-678. [PMID: 34934033 DOI: 10.1097/iae.0000000000003383] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the prevalence and characteristics of multifocal choroiditis/punctate inner choroidopathy (MFC/PIC) in eyes with patchy atrophy because of pathologic myopia. METHODS Five hundred eyes of 253 patients with patchy atrophy were examined between 2014 and 2020 at the Advanced Clinical Center for Myopia. The main outcome measures included the prevalence and characteristics of active MFC/PIC lesions diagnosed by optical coherence tomography. RESULTS Fifty-five of the 500 eyes (11%) diagnosed with patchy atrophy had optical coherence tomography features of active MFC/PIC lesions, such as focal elevations of the retinal pigment epithelium filled with medium hyperreflectivity material, curvilinear scars (Schlaegel lines), and/or areas of outer retinal atrophy. At the time when the MFC/PIC was diagnosed, the mean age was 57.3 ± 12.0 years, and the mean axial length was 29.2 ± 1.8 mm. Macular neovascularization was found in 45 of eyes (81.8%) with MFC/PIC versus 151 eyes without such findings (33.9%; P < 0.001). In 25 of the 55 eyes (45.5%), active MFC/PIC lesions were found before the development of the patchy atrophy. The Bruch membrane defects were colocated with these lesions. CONCLUSION Active MFC/PIC lesions were identified in a minority of eyes with pathologic myopia, and a subset of these lesions were observed to progress to findings indistinguishable from myopic patchy atrophy. Evidence of MFC/PIC in eyes with pathologic myopia appeared to be a risk factor for the development of macular neovascularization.
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Affiliation(s)
- Shymaa K Hady
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shiqi Xie
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, New York University, New York, New York
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California
- The Department of Ophthalmology, Stanford University School of Medicine, Stanford, California
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, California
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; and
- Duke-NUS Medical School, Singapore, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore; and
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tae Igarashi-Yokoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Omar M Ali
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ehab I Wasfi
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mahmoud F Rateb
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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Erba S, Cozzi M, Xhepa A, Cereda M, Staurenghi G, Invernizzi A. Distribution and Progression of Inflammatory Chorioretinal Lesions Related to Multifocal Choroiditis and Their Correlations with Clinical Outcomes at 24 Months. Ocul Immunol Inflamm 2022; 30:409-416. [DOI: 10.1080/09273948.2020.1800048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Stefano Erba
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alba Xhepa
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Matteo Cereda
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science “Luigi Sacco” Luigi Sacco Hospital, University of Milan, Milan, Italy
- Faculty of Health and Medicine, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
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8
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Park JG, Halim MS, Uludag G, Onghanseng N, Sredar N, Sepah YJ, Nguyen QD. Distinct Patterns of Choroidal Lesions in Punctate Inner Choroidopathy and Multifocal Choroiditis Determined by Heatmap Analysis. Ocul Immunol Inflamm 2022; 30:276-281. [PMID: 34228580 PMCID: PMC10889846 DOI: 10.1080/09273948.2021.1939391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE A heatmap analysis of choroidal lesions in patients with punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) with or without uveitis was performed to determine if there were any distinguishing features among these uveitic entities. METHODS Retrospective review of medical records was conducted at the Byers Eye Institute, Stanford. Fundus photographs were masked and placed on a standardized template. Lesions were identified and heatmaps were generated in a standardized fashion. RESULTS 30 eyes were identified with PIC or MFC. Heatmap analysis revealed three distinct patterns of fundus lesions: posterior, peripheral, and combined. All patients with PIC had the posterior pattern. Patients with MFC had the peripheral or combined pattern, and all patients with MFC with uveitis had the combined pattern. CONCLUSION Three patterns of fundus lesions were identified in patients with PIC and MFC. PIC and MFC may represent two separate disease entities with distinct phenotypes of choroidal lesions.
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Affiliation(s)
- Jong G Park
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Muhammad Sohail Halim
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Gunay Uludag
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Nripun Sredar
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
- Ocular Imaging Research and Reading Center, Sunnyvale, California, USA
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Outcomes of adalimumab therapy in refractory punctate inner choroidopathy and multifocal choroiditis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2013-2021. [PMID: 34982218 DOI: 10.1007/s00417-021-05539-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study aims to evaluate the outcomes of adalimumab (ADA) therapy in patients with refractory punctate inner choroidopathy (PIC) and multifocal choroiditis (MFC). METHODS Demographic and clinical data, including LogMAR best-corrected visual acuity (BCVA), were retrospectively collected. Doses of prednisone, immunomodulatory therapies (IMT), and anti-vascular endothelial growth factor (VEGF) injections before and after baseline (ADA initiation) were recorded, as well as the time to clinical remission, time to first flare, and drug-associated adverse events. RESULTS Seven patients (4 females, ten eyes) were included. The mean follow-up after baseline was 17.8 ± 11.1 months (range 6-33). The mean LogMAR BCVA was 0.35 ± 0.77 at 6 months before baseline and remained stable throughout 12 months after baseline (0.31 ± 0.46 at 12 months; p = 0.47). The mean dose of prednisone decreased from 17.3 ± 19.6 mg/day 6 months before baseline (range 0-60) to 2.6 ± 2.4 mg/day at the last follow-up (range 0-6, p = 0.03). The mean number of flares decreased significantly from 1.43 ± 0.79 over a 6-month period before baseline to 0.2 ± 0.45 (p = 0.02) at 6-12 months after baseline. The mean number of anti-VEGF injections was 4.17 ± 3.92 over the 12-month period before baseline, and it was 2.17 ± 3.06 (p = 0.31) during the first 12 months after baseline. No adalimumab-related adverse events were noted. CONCLUSION Adalimumab therapy for refractory PIC/MFC enabled a significant steroid-sparing effect, decreased disease flares, and preserved vision over a mean follow-up of 17.8 months.
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Leclaire MD, Clemens CR, Eter N, Mihailovic N. [Choroidal neovascularization due to a punctate inner choroidopathy visualized by optical coherence tomography angiography]. Ophthalmologe 2021; 118:842-846. [PMID: 32767099 PMCID: PMC8342402 DOI: 10.1007/s00347-020-01200-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Punctate inner choroidopathy (PIC) is often accompanied by the development of choroidal neovascularization (CNV). The identification of a fresh CNV in the context of PIC is often difficult. We present the case of a 30-year-old female patient with typical morphological features of PIC. A CNV could not be detected with certainty by optical coherence tomography (OCT) or by fluorescein angiography (FAG); however, OCT angiography (OCT-A) revealed a circumscribed CNV. The case suggests that there are a high number of undiagnosed, subclinical secondary CNVs not requiring treatment in PIC patients.
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Affiliation(s)
- Martin Dominik Leclaire
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland.
| | - Christoph R Clemens
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Nicole Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Nataša Mihailovic
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Domagkstr. 15, 48149, Münster, Deutschland
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11
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Classification Criteria for Punctate Inner Choroiditis. Am J Ophthalmol 2021; 228:275-280. [PMID: 33845011 PMCID: PMC8675391 DOI: 10.1016/j.ajo.2021.03.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to determine classification criteria for punctate inner choroiditis (PIC). DESIGN Machine learning of cases with PIC and 8 other posterior uveitides. METHODS Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis by using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the posterior uveitides. The resulting criteria were evaluated in the validation set. RESULTS A total of 1,068 cases of posterior uveitides, including 144 cases of PIC, were evaluated by machine learning. Key criteria for PIC included: 1) "punctate"-appearing choroidal spots <250 µm in diameter; 2) absent to minimal anterior chamber and vitreous inflammation; and 3) involvement of the posterior pole with or without mid-periphery. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval: 94.3-99.3) in the validation set. The misclassification rates for PIC were 15% in the training set and 9% in the validation set. CONCLUSIONS The criteria for PIC had a reasonably low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
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12
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Gan Y, Su Y, Zhang Y, Zhang X, Liao N, Wen F. Patchy hyperautofluorescence as a predictive factor for the recurrence of punctate inner choroidopathy. Photodiagnosis Photodyn Ther 2020; 33:102146. [PMID: 33359163 DOI: 10.1016/j.pdpdt.2020.102146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate baseline clinical and imaging factors that may correlate with risk of recurrence of punctate inner choroidopathy (PIC). METHODS In this retrospective observational study, charts and multimodal imaging of forty-five patients diagnosed with PIC during the active inflammatory phase were reviewed. MMI examinations, including fundus photography, shortwave fundus autofluorescence(SW-FAF), fluorescein angiography(FFA), indocyanine green angiography(ICGA), and spectral domain optical coherence tomography(SD-OCT_), were conducted to diagnose PIC, and MMI parameters at baseline were assessed as potential biomarkers indicating the recurrence of inflammation. Statistical analysis was performed to determine the clinical and imaging factors associated with recurrence of PIC. RESULTS Among the 45 recruited patients, 18 (40 %) had at least one episode of recurrence during a mean follow-up period of 23.66 ± 12.65 months (range, 12-50 months). Best corrected visual acuity (BCVA) at the final visit during the follow-up was significantly different between the recurrence and nonrecurrence groups. Patchy hyperautofluorescence at baseline appeared in 77.78 % of the patients with recurrence, and the incidence of patchy hyperautofluorescence was significantly different between the patients with recurrence and those without recurrence (P<0.001). CONCLUSIONS Recurrence is not rare among PIC patients and leads to a worse visual acuity outcome. Patchy hyperautofluorescence at baseline is a risk factor for recurrence of PIC. Patchy hyperautofluorescent areas in PIC patients may indicate a need for close follow-up even though PIC-related inflammation regresses.
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Affiliation(s)
- Yuhong Gan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, China
| | - Yongyue Su
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, China
| | - Yuxin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, China
| | - Nanying Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, China.
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13
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Niederer R, Bar A, Al-Ani H, Sharief L, Sar S, Segal A, Lightman S, Tomkins-Netzer O. Management of inflammatory choroidal neovascular membranes. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2021.1842196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachael Niederer
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Asaf Bar
- Department of Ophthalmology, Wolfson Medical Centre, Tel Aviv-Yafo, Israel
| | - Haya Al-Ani
- University of Auckland, Auckland District Health Board, Auckland, New Zealand
| | - Lazha Sharief
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Shaul Sar
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Adi Segal
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sue Lightman
- UCL/Institute of Ophthalmology and Moorfileds Eye Hospital, London, UK
| | - Oren Tomkins-Netzer
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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14
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Ometto G, Montesano G, Sadeghi Afgeh S, Lazaridis G, Liu X, Keane PA, Crabb DP, Denniston AK. Merging Information From Infrared and Autofluorescence Fundus Images for Monitoring of Chorioretinal Atrophic Lesions. Transl Vis Sci Technol 2020; 9:38. [PMID: 32908801 PMCID: PMC7453042 DOI: 10.1167/tvst.9.9.38] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop a method for automated detection and progression analysis of chorioretinal atrophic lesions using the combined information of standard infrared (IR) and autofluorescence (AF) fundus images. Methods Eighteen eyes (from 16 subjects) with punctate inner choroidopathy were analyzed. Macular IR and blue AF images were acquired in all eyes with a Spectralis HRA+OCT device (Heidelberg Engineering, Heidelberg, Germany). Two clinical experts manually segmented chorioretinal lesions on the AF image. AF images were aligned to the corresponding IR. Two random forest models were trained to classify pixels of lesions, one based on the AF image only, the other based on the aligned IR-AF. The models were validated using a leave-one-out cross-validation and were tested against the manual segmentation to compare their performance. A time series from one eye was identified and used to evaluate the method based on the IR-AF in a case study. Results The method based on the AF images correctly classified 95% of the pixels (i.e., in vs. out of the lesion) with a Dice's coefficient of 0.80. The method based on the combined IR-AF correctly classified 96% of the pixels with a Dice's coefficient of 0.84. Conclusions The automated segmentation of chorioretinal lesions using IR and AF shows closer alignment to manual segmentation than the same method based on AF only. Merging information from multimodal images improves the automatic and objective segmentation of chorioretinal lesions even when based on a small dataset. Translational Relevance Merged information from multimodal images improves segmentation performance of chorioretinal lesions.
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Affiliation(s)
- Giovanni Ometto
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Giovanni Montesano
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Georgios Lazaridis
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Centre for Medical Image Computing, University College London, London, UK
| | - Xiaoxuan Liu
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Health Data Research UK, London, UK
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Health Data Research UK, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Health Data Research UK, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK
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15
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Gilbert RM, Niederer RL, Kramer M, Sharief L, Sharon Y, Bar A, Lightman S, Tomkins-Netzer O. Differentiating Multifocal Choroiditis and Punctate Inner Choroidopathy: A Cluster Analysis Approach. Am J Ophthalmol 2020; 213:244-251. [PMID: 32027868 DOI: 10.1016/j.ajo.2020.01.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/30/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To develop a robust approach to clinical phenotyping of multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC). DESIGN Cross-sectional and longitudinal observational study. METHODS This multicenter study included sites in the United Kingdom and Israel. The study population included 343 eyes of 185 subjects with hospital record diagnoses of MFC or PIC. Eyes were observed over a period of 5 years for clinically relevant characteristics, including demographics and multimodal imaging features, by observers masked to the original diagnoses. Multivariate 2-step cluster analysis was used to identify clusters of eyes in the database with similar clinical phenotypes, which were then analyzed for between-group differences. The primary outcome measure was the difference between clinical phenotype clusters identified using clinical criteria from the multivariate cluster analysis. RESULTS Subjects ranged from 11 to 89 years of age, with a baseline best-corrected visual acuity of 2.3 to -0.2 logarithm of minimal angle of resolution. Eighty-two percent of eyes were from females, 74% were myopic with a refractive error of +3.00 to -17.00 diopters (spherical equivalent). Cluster analysis prioritized clinical criteria of chorioretinal lesion location and intraocular inflammation and identified 2 distinct phenotype clusters resembling the original descriptions of MFC and PIC. During the 5-year period of observation, the initial clinical diagnosis remained stable for most eyes and only 1 eye (0.3%) changed diagnosis from PIC to MFC because of newly developed peripheral lesions. There were significant between-group differences in clinical characteristics, for example, in choroidal neovascular membrane development and treatment received. CONCLUSIONS Cluster analysis of this large cohort of eyes identified peripheral lesions and intraocular inflammation as distinct clinical phenotypes of MFC and PIC. The initial diagnosis remained stable for most eyes. This methodology could be useful for future uveitis classification and management.
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Affiliation(s)
- Rose M Gilbert
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom.
| | - Rachael L Niederer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Greenlane Medical CentreAuckland District Health Board, Auckland, New Zealand
| | - Michal Kramer
- Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lazha Sharief
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Yael Sharon
- Rabin Medical Center, Petah Tikva, Israel; Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey, USA
| | - Asaf Bar
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Wolfson Medical Centre, Holon, Tel Aviv-Yafo, Israel
| | - Sue Lightman
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital National Health Service Foundation Trust, City Road, London, United Kingdom; University College London Institute of OphthalmologyBath Street, London, United Kingdom; Carmel Medical Center, Haifa, Israel
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Hua R, Ning H. Using optical coherence tomography angiography to guide the treatment of pathological myopic patients with submacular hemorrhage. Photodiagnosis Photodyn Ther 2019; 28:105-109. [PMID: 31470121 DOI: 10.1016/j.pdpdt.2019.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
The present study aimed to investigate whether optical coherence tomography angiography (OCTA) could be used to guide the treatment of pathological myopic patients with submacular hemorrhage. Two pathological myopia patients with submacular hemorrhage were examined. Initially, choroidal neovascularization (CNV) was not observed during fundus angiography in both patients. However, based on OCTA, the first patient was diagnosed with myopic lacquer crack-related macular hemorrhage, and the second with CNV secondary to punctate inner choroidopathy. The first patient was treated with traditional Chinese medicine administered orally, and the second with intravitreal injections of anti-vascular endothelial growth factor (VEGF). Lesions in both patients were resolved. Submacular hemorrhage in pathological myopia patients could be caused by numerous mechanisms. OCTA is useful in differentiating inflammatory CNV from inflammatory lesions, particularly if CNV is not detected using other multimodal imaging techniques.
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Affiliation(s)
- Rui Hua
- Ophthalmology, The First Affiliated Hospital of China Medical University, No. 155, Nanjingbei Street, Shenyang, 110001, China
| | - Hong Ning
- Ophthalmology, The First Affiliated Hospital of China Medical University, No. 155, Nanjingbei Street, Shenyang, 110001, China.
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17
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Chen SN, Chen YL, Yang BCL. Long-Term Outcome of Punctate Inner Choroidopathy or Multifocal Choroiditis with Active Choroidal Neovascularization Managed with Intravitreal Bevacizumab. Ocul Immunol Inflamm 2019; 28:33-38. [DOI: 10.1080/09273948.2019.1588335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan
- Department of Optometry, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
- Department of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- Department of Medicine, Kao-Hsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ling Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua City, Taiwan
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18
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Lee JH, Lee SC, Park SJ, Lee CS. Punctate Inner Choroidopathy and Choroidal Neovascularization in Korean Patients. Ocul Immunol Inflamm 2018; 28:14-19. [DOI: 10.1080/09273948.2018.1489060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ji Hwan Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Chul Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Seo Jin Park
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
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19
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Pohlmann D, Pleyer U, Joussen AM, Winterhalter S. Immunosuppressants and/or antivascular endothelial growth factor inhibitors in punctate inner choroidopathy? Follow-up results with optical coherence tomography angiography. Br J Ophthalmol 2018; 103:1152-1157. [DOI: 10.1136/bjophthalmol-2018-312455] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/04/2022]
Abstract
PurposeTo report the effectiveness of treatment with antivascular endothelial growth factor (VEGF)-inhibitor and/or immunosuppressants in punctate inner choroidopathy (PIC) using standard imaging modalities and optical coherence tomography angiography (OCTA) over a time period of 16 months.MethodsIn this prospective, unmasked, single-centre study, 23 individuals with PIC underwent imaging with spectral domain OCT, fluorescein angiography, indocyanine green angiography and OCTA. Two groups were formed based on systemic treatment. In case of choroidal neovascularisation (CNV) activity, intravitreal anti-VEGF injections were carried out in both groups.ResultsGroup I included 12 patients (24 eyes) with 18 affected eyes (75%) who did not receive any systemic therapy at baseline. Group II contained 11 patients (22 eyes) who started systemic immunosuppressive therapy on average 2 years before baseline. All eyes with recurrence of CNV or residual fluid (group I: seven eyes; group II: six eyes) received anti-VEGF agents. Group I showed a significant reduction of CNV size (p=0.0078), as well as a decrease of fluid retention (p=0.0078) on OCTA after anti-VEGF injection. Group II did not demonstrate any significant reduction of CNV size, vessel shape or fluid retention post injection. But overall, fluid accumulation was significantly lower in group II (median=0.03 mm2) than in group I (median=0.32 mm2) (p=0.0028).ConclusionImmunosuppressants in addition to anti-VEGF agents showed a significant reduction of fluid accumulation, that is, reduced disease activity. We conclude that there is a benefit and effectiveness of immunosuppressants to control inflammatory secondary CNV in PIC.
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20
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Treatment of Punctate Inner Choroidopathy with Choroidal Neovascularization Using Corticosteroid and Intravitreal Ranibizumab. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1585803. [PMID: 30302336 PMCID: PMC6158959 DOI: 10.1155/2018/1585803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022]
Abstract
Background To evaluate the treatment outcomes of patients with punctate inner choroidopathy (PIC) and secondary choroidal neovascularization (CNV). Methods This is a retrospective study of 24 eyes in 22 patients suffering from PIC with CNV. Patients were treated with intravitreal ranibizumab monotherapy (14 eyes) or combined oral corticosteroid and intravitreal ranibizumab therapy (corticosteroid-ranibizumab group, 10 eyes). Mean follow-up duration was 24.0 months. We evaluated best-corrected visual acuity (BCVA), fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and optical coherence tomography, before and after treatment. The following variables were compared between groups: number of intravitreal ranibizumab injections, BCVA, recurrence of CNV, and change in PIC lesions. Results The ranibizumab monotherapy group received an average of 3 intravitreal ranibizumab injections; mean logMAR visual acuity improvement was 0.34, and 8 eyes developed recurrent CNV during follow-up. The corticosteroid-ranibizumab group received an average of 1.9 intravitreal ranibizumab injections; mean logMAR visual acuity improvement was 0.61, and there was no recurrence of CNV. Combined corticosteroid-ranibizumab therapy also resulted in better resolution of PIC lesions and fewer new PIC lesions. Conclusion Both corticosteroid-ranibizumab treatment and ranibizumab monotherapy could significantly improve the vision of PIC patients with CNV. Combined corticosteroid and intravitreal ranibizumab treatment appeared to reduce CNV recurrence and development of new PIC lesions compared with ranibizumab monotherapy.
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21
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Shah D, Khedia D, Saurabh K, Roy R. Multimodal imaging signatures in a case of acute zonal occult outer retinopathy. Indian J Ophthalmol 2018; 66:1349-1352. [PMID: 30127169 PMCID: PMC6113798 DOI: 10.4103/ijo.ijo_264_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Acute zonal occult outer retinopathy (AZOOR) is a retinal disease characterized by a slow onset loss of retinal function with minimally evident fundus changes. Patients with AZOOR present with initially progressive scotoma and photopsia. Its pathogenesis has not been definitively determined as of yet. Characteristically, the extent of the visual field defect is unexplained by fundus examination, but there is marked retinal dysfunction, which is evident on multimodal imaging and electrophysiological testing. We herein describe multimodal imaging signatures of AZOOR, in a patient of Indian origin, highlighting the hitherto unreported multicolor channels and near-infrared autofluorescence.
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Affiliation(s)
- Dhaivat Shah
- Department of Vitreoretinal Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Deepika Khedia
- Department of Vitreoretinal Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Kumar Saurabh
- Department of Vitreoretinal Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Rupak Roy
- Department of Vitreoretinal Services, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
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22
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The Role of Optical Coherence Tomography Angiography in the Management of Uveitis. Int Ophthalmol Clin 2018; 56:1-24. [PMID: 27575755 DOI: 10.1097/iio.0000000000000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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23
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Niederer RL, Gilbert R, Lightman SL, Tomkins-Netzer O. Risk Factors for Developing Choroidal Neovascular Membrane and Visual Loss in Punctate Inner Choroidopathy. Ophthalmology 2018; 125:288-294. [DOI: 10.1016/j.ophtha.2017.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 07/27/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022] Open
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24
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Kim EL, Thanos A, Yonekawa Y, Todorich B, Wolfe J, Randhawa S, Faia LJ. Optical Coherence Tomography Angiography Findings in Punctate Inner Choroidopathy. Ophthalmic Surg Lasers Imaging Retina 2017; 48:786-792. [DOI: 10.3928/23258160-20170928-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 08/28/2017] [Indexed: 11/20/2022]
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25
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Peng Y, Zhang X, Mi L, Liu B, Zuo C, Li M, Wen F. Efficacy and safety of conbercept as a primary treatment for choroidal neovascularization secondary to punctate inner choroidopathy. BMC Ophthalmol 2017; 17:87. [PMID: 28606070 PMCID: PMC5468989 DOI: 10.1186/s12886-017-0481-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 05/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the efficacy and safety of intravitreal conbercept (KH902) as the primary treatment of choroidal neovascularization secondary to punctate inner choroidopathy. Methods This study was a retrospective, consecutive, observational case series. We reviewed medical records of 16 eyes (16 patients) with naive subfoveal or juxtafoveal choroidal neovascularization secondary to punctuate inner choroidopathy that were treated with intravitreal conbercept injections. All patients completed at least six months of follow-up. Best-corrected visual acuity (BCVA) was measured, and anatomical features were assessed with fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Results At the month-6 follow-up visit, best-corrected visual acuity improved from 0.70 ± 0.36 (with approximate Snellen equivalent of 20/100) to 0.44 ± 0.25 (20/50 in Snellen) logarithm of the minimum angle of resolution (logMAR) (P = 0.003). Mean improvement of vision was 2.6 lines, with 50% treated eyes (8 eyes of 16) showing an improvement of ≥3 lines and 62.5% (10 eyes of 16), obtaining an improvement of ≥2 lines; all 16 eyes had stable or improved vision. Mean central retinal thickness decreased from 294.94 ± 102.68 μm to 206.56 ± 61.71 μm (P = 0.005). Fifteen eyes (93.75%) showed absence of CNV leakage at the end of the study period. No conbercrept-related systemic or ocular adverse events were observed. Conclusion Intravitreal injection of conbercept significantly improved visual and anatomical outcomes in choroidal neovascularization secondary to punctate inner choroidopathy over a 6-month follow-up period. Trial registration ISRCTN85678307, retrospectively registered on May 11, 2017.
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Affiliation(s)
- Yuting Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Xiongze Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Lan Mi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Bing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Miaoling Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China
| | - Feng Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 South Xianlie Road, Guangzhou, 510060, China.
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26
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Barth T, Zeman F, Helbig H, Gamulescu MA. Intravitreal anti-VEGF treatment for choroidal neovascularization secondary to punctate inner choroidopathy. Int Ophthalmol 2017; 38:923-931. [PMID: 28424992 DOI: 10.1007/s10792-017-0536-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/10/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the outcome of patients with choroidal neovascularization (CNV) secondary to punctate inner choroidopathy (PIC) receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections. METHODS Sixteen eyes of 16 patients diagnosed with CNV secondary to PIC were retrospectively assessed. RESULTS Eleven women and five men with a mean age of 35 years (SD 11, range 16-56 years) received intravitreal anti-VEGF for PIC-related CNV. On average, 3.5 injections (SD 2.7, range 1-9) were given per eye. Thirteen eyes were treated with bevacizumab, two eyes with ranibizumab and one eye received both substances. The mean follow-up was 15 months (SD 11, range 6-40 months). BCVA improved in eight eyes (mean Δ +2.8 lines), remained stable in four eyes and decreased in four eyes (mean Δ -4.3 lines). CONCLUSIONS CNV development is a frequent complication of PIC. Intravitreal anti-VEGF therapy seems to be safe and effective for PIC-related CNV.
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Affiliation(s)
- T Barth
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - F Zeman
- Centre for Clinical Studies (ZKS), University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - H Helbig
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - M-A Gamulescu
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Brydak-Godowska J, Gołębiewska J, Turczyńska M, Moneta-Wielgoś J, Samsel A, Borkowski PK, Ciszek M, Płonecka-Rodzoch A, Kużnik-Borkowska A, Ciszewska J, Makomaska-Szaroszyk E, Brydak LB, Kęcik D. Observation and Clinical Pattern in Patients with White Dot Syndromes: The Role of Color Photography in Monitoring Ocular Changes in Long-Term Observation. Med Sci Monit 2017; 23:1106-1115. [PMID: 28253223 PMCID: PMC5345700 DOI: 10.12659/msm.901744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study was to assess the clinical course and distinctive features of different white dot syndromes (WDS) in patients attending the Ophthalmology Department, Medical University of Warsaw in the years 1995–2015. Material/Methods Sixty-two (62) patients (43 females and 19 males), aged 18 to 77 years, referred with a WDS were included in this prospective study, with observation period ranging from 5 months to 16 years. All patients underwent a complete ophthalmological examination and multimodal imaging studies. Results In this cohort of 62 patients, the following WDS entities were identified: multifocal choroiditis with panuveitis (MFCPU), multifocal choroiditis (MFC), punctate inner choroidopathy (PIC), birdshot, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), subretinal fibrosis and uveitis, multiple evanescent white dot syndrome (MEWDS), serpiginous choroiditis, and single cases of acute annular outer retinopathy (AAOR). Conclusions The study was performed at a Polish referral center and may to some extent reflect the varied geographical distribution of white dot syndromes, as none of the subjects was found to suffer from acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy (AMN), or diffuse unilateral subacute neuroretinitis (DUSN). Long-term follow-up is warranted by the evolution of lesions in the eye fundus, while management depends on correct diagnosis of WDS. When the posterior pole is involved in some cases of the WDS an immunosuppressive treatment, the use of the PDT or anti-VEGF injections were necessary.
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Affiliation(s)
| | - Joanna Gołębiewska
- Department of Ophthalmology, Children's Memorial Health Institute, Warsaw, Poland
| | - Monika Turczyńska
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | - Agnieszka Samsel
- Department of Ophthalmology, Children's Jan Bogdanowicz Hospital, Warsaw, Poland
| | - Piotr K Borkowski
- Department of Infectious and Tropical Diseases and Hepatology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Ciszek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Joanna Ciszewska
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Dariusz Kęcik
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
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Shin MH, Kang HJ, Chung IY. Recurrence of Punctate Inner Choroidopathy with an Intravitreal Dexamethasone Implant. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.11.1282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Ho Shin
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun Ji Kang
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
- Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Ahnood D, Madhusudhan S, Tsaloumas MD, Waheed NK, Keane PA, Denniston AK. Punctate inner choroidopathy: A review. Surv Ophthalmol 2016; 62:113-126. [PMID: 27751823 DOI: 10.1016/j.survophthal.2016.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Abstract
Punctate inner choroidopathy (PIC), an idiopathic inflammatory multifocal chorioretinopathy that predominantly affects young myopic women, appears to be relatively rare, but there are limited data to support accurate estimates of prevalence, and it is likely that the condition is underdiagnosed. The etiological relationship between PIC and other conditions within the "white dot syndromes" group remains uncertain. We, like others, would suggest that PIC and multifocal choroiditis with panuveitis represent a single disease process that is modified by host factors (including host immunoregulation) to cause the range of clinical phenotypes seen. The impact of PIC on the patient is highly variable, with outcome ranging from complete spontaneous recovery to bilateral severe sight loss. Detection and monitoring have been greatly facilitated by modern scanning techniques, especially optical coherence tomography and autofluorescence imaging and may be enhanced by coregistration of sequential images to detect change over time. Depending on the course of disease and nature of complications, appropriate treatment may range from observation to systemic immunosuppression and antiangiogenic therapies. PIC is a challenging condition where treatment has to be tailored to the patient's individual circumstances, the extent of disease, and the risk of progression.
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Affiliation(s)
- Dana Ahnood
- Department of Ophthalmology, Royal Glamorgan Hospital, Cwm Taf University Health Board, Cardiff, United Kingdom
| | - Savitha Madhusudhan
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Marie D Tsaloumas
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom; Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, University of Birmingham, Birmingham, United Kingdom.
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CHORIORETINAL WHITE DOT LESIONS IN EYES WITH MULTIFOCAL CHOROIDITIS AND TILTED DISK SYNDROME WITH INFERIOR STAPHYLOMA. Retina 2016; 37:154-160. [PMID: 27380431 DOI: 10.1097/iae.0000000000001135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the influence of tilted disk syndrome (TDS) and inferior staphyloma on the macular clinical expression of MFC. METHODS Medical charts of patients with MFC examined since 2009 were reviewed retrospectively. All patients underwent standard examination and multimodal imaging including fundus color photography, fundus autofluorescence, and spectral domain optical coherence tomography. Two groups of patients were compared : Group 1 with TDS and inferior staphyloma and Group 2 without. The number of MFC spots were counted and normalized to the surface area in a circle centered about the fovea. In Group 1, the number of lesions inside the staphyloma was compared with that outside the staphyloma. RESULTS At baseline, 8 eyes in Group 1 had a mean (±SD) higher number of chorioretinal lesions outside the staphyloma (14.5 [±7.2]) than within the staphyloma (5 [±5.5]) (P = 0.017). All 11 eyes in Group 2 had chorioretinal lesions homogeneously distributed in the posterior pole. Eyes with TDS and inferior staphyloma developed choroidal neovascularization more frequently (6/8 eyes) than eyes without TDS (5/11 eyes) (P = 0.026). CONCLUSION Inferior staphyloma associated with TDS could modulate the clinical expression of the inflammatory and neovascular process in eyes with MFC.
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Yung M, Klufas MA, Sarraf D. Clinical applications of fundus autofluorescence in retinal disease. Int J Retina Vitreous 2016; 2:12. [PMID: 27847630 PMCID: PMC5088473 DOI: 10.1186/s40942-016-0035-x] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/15/2016] [Indexed: 12/30/2022] Open
Abstract
Fundus autofluorescence (FAF) is a non-invasive retinal imaging modality used in clinical practice to provide a density map of lipofuscin, the predominant ocular fluorophore, in the retinal pigment epithelium. Multiple commercially available imaging systems, including the fundus camera, the confocal scanning laser ophthalmoscope, and the ultra-widefield imaging device, are available to the clinician. Each offers unique advantages for evaluating various retinal diseases. The clinical applications of FAF continue to expand. It is now an essential tool for evaluating age related macular degeneration, macular dystrophies, retinitis pigmentosa, white dot syndromes, retinal drug toxicities, and various other retinal disorders. FAF may detect abnormalities beyond those detected on funduscopic exam, fluorescein angiography, or optical coherence tomography, and can be used to elucidate disease pathogenesis, form genotype-phenotype correlations, diagnose and monitor disease, and evaluate novel therapies. Given its ease of use, non-invasive nature, and value in characterizing retinal disease, FAF enjoys increasing clinical relevance. This review summarizes common ocular fluorophores, imaging modalities, and FAF findings for a wide spectrum of retinal disorders.
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Affiliation(s)
- Madeline Yung
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, CA 90095 USA
| | - Michael A. Klufas
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, CA 90095 USA
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine at University of California, Los Angeles, CA 90095 USA
- Greater Los Angeles VA Healthcare Center, Los Angeles, CA 90024 USA
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Hohberger B, Rudolph M, Bergua A. Choroidal Neovascularization Associated with Punctate Inner Choroidopathy: Combination of Intravitreal Anti-VEGF and Systemic Immunosuppressive Therapy. Case Rep Ophthalmol 2016; 6:385-9. [PMID: 26955337 PMCID: PMC4777951 DOI: 10.1159/000441694] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Choroidal neovascularization (CNV) associated with punctate inner choroidopathy (PIC) is a rare clinical entity, yet still a challenge for medical treatment. A case of a young myopic woman developing CNV secondary to unilateral PIC is presented. Clinical morphology, diagnostic procedure and follow-up are reported. Case Report A 29-year-old woman presented with multiple yellowish dots at the posterior pole. No other signs of inflammation could be seen. Angiography with fluorescein yielded hyperfluorescent signals in the affected areas with a diffuse leak, and SD-OCT showed a slightly elevated retinal pigment epithelial layer, consistent with the diagnosis of PIC. Additionally a classic CNV was observed. Results Anti-inflammatory therapy with local prednisolone acetate eye drops in combination with intravitreal injection of anti-vascular endothelial growth factor (VEGF, bevacizumab) yielded an increased best-corrected visual acuity. As CNV reappeared, systemic medication with prednisone and azathioprine in combination with two further intravitreal injections of anti-VEGF stabilized CNV and increased visual acuity again. Conclusion Combined therapy of immunosuppression with intravitreal anti-VEGF injections can be considered as therapeutic strategy in the management of recurrent CNV associated with PIC.
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Affiliation(s)
- Bettina Hohberger
- Department of Ophthalmology and Eye Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Rudolph
- Department of Ophthalmology and Eye Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Antonio Bergua
- Department of Ophthalmology and Eye Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Chou YB, Chung YC, Chen SJ, Lee FL, Yang CS. A novel view of punctate inner choroidopathy: Characterizing the serial changes by high resolution spectrum-domain optical coherence tomography. Taiwan J Ophthalmol 2014. [DOI: 10.1016/j.tjo.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Zarranz-Ventura J, Sim DA, Keane PA, Patel PJ, Westcott MC, Lee RW, Tufail A, Pavesio CE. Characterization of Punctate Inner Choroidopathy Using Enhanced Depth Imaging Optical Coherence Tomography. Ophthalmology 2014; 121:1790-7. [DOI: 10.1016/j.ophtha.2014.03.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 03/08/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022] Open
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CLINICAL FEATURES AND INCIDENCE RATE OF OCULAR COMPLICATIONS IN PUNCTATE INNER CHOROIDOPATHY. Retina 2014; 34:1666-74. [DOI: 10.1097/iae.0000000000000125] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hua R, Liu L, Chen L. Evaluation of the progression rate of atrophy lesions in punctate inner choroidopathy (PIC) based on autofluorescence analysis. Photodiagnosis Photodyn Ther 2014; 11:565-9. [PMID: 25046400 DOI: 10.1016/j.pdpdt.2014.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/06/2014] [Accepted: 07/08/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the autofluorescence (AF) characteristics of punctate inner choroidopathy (PIC) and to evaluate the progression rate of retinal pigment epithelium (RPE) atrophy lesions in PIC using confocal scanning laser ophthalmoscopy. METHODS Twenty-two eyes of 14 PIC cases and 21 eyes of 21 non-proliferative diabetic retinopathy (NPDR) cases which received retinal coagulation as a control group were enrolled in this study. Enhanced depth imaging optical coherence tomography (EDI-OCT) and AF were recorded from all patients at 18 months follow-up. The RPE atrophy areas of PIC and laser scars in NPDR were analyzed using the Region Finder software of the Heidelberg Eye Explorer. This software allows direct export of AF images from the database and semi-automated detection of atrophic areas by shadow correction, vessel detection, and selection of seed points. RESULTS At baseline, both hyperfluorescence and hypofluorescence were observed in the lesions of PIC eyes with a focal elevation of RPE and corresponding disruption of the ellipsoid region of the inner segment ellipsoid zone (EZ). In contrast, hypo-AF was detected when there was a lack of RPE. The mean progression rate of RPE atrophy in PIC and NPDR were 3.735 mm(2)/year (0.056-0.545) and 0.127 mm(2)/year (0.015-0.466), respectively. Compared with the atrophy area in the last visit, the progression rate in PIC was significantly greater than that in NPDR (Z=5.615, P<0.0001). CONCLUSIONS The results of AF reflect the status of PIC and the progression rate of RPE atrophy in PIC, which can be used to predict the progress of PIC noninvasively.
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Affiliation(s)
- Rui Hua
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, China
| | - Limin Liu
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, China
| | - Lei Chen
- Department of Ophthalmology, First Hospital of China Medical University, Shenyang, China.
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Hirooka K, Saito W, Hashimoto Y, Saito M, Ishida S. Increased macular choroidal blood flow velocity and decreased choroidal thickness with regression of punctate inner choroidopathy. BMC Ophthalmol 2014; 14:73. [PMID: 24885365 PMCID: PMC4041897 DOI: 10.1186/1471-2415-14-73] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 05/21/2014] [Indexed: 11/21/2022] Open
Abstract
Background Changes in choroidal circulation hemodynamics during the course of punctate inner choroidopathy (PIC) remain unknown. The aim of this study was to quantitatively evaluate changes in choroidal blood flow velocity by using laser speckle flowgraphy (LSFG) in patients with PIC. Case presentation This PIC patient was initially treated with systemic corticosteroids for 4 months. LSFG measurements were taken 10 consecutive times before treatment and at 1, 3, 12, 20 and 23 months after the initiation of therapy. The mean blur rate (MBR), a quantitative index of relative blood flow velocity, was calculated using LSFG in three regions: Circles 1, 2 and 3 were set at the fovea, a lesion site, and an area of normal-appearing retina, respectively. The PIC lesions scarred after treatment along with improvements in visual function and outer retinal morphology. When the changing rate of macular flow over the 12-month follow-up period was compared with the MBR before treatment (100%), an increase of 16–37%, 24–49% and 15–18% was detected in Circles 1, 2 and 3, respectively. At the time of PIC recurrence after 20 months, the MBR decreased temporarily but subsequently increased after retreatment with systemic corticosteroids. This trend was accompanied by a decrease in choroidal thickness at the lesion site after retreatment. Conclusions Macular choroidal blood flow velocity increased and choroidal thickness decreased concurrently with regression of PIC. The present findings suggest that inflammation-related impairments in choroidal circulation may relate to the pathogenesis of PIC, extending over a wider area in the posterior pole than the PIC lesions per se.
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Affiliation(s)
| | - Wataru Saito
- Department of Ophthalmology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Gender differences in birdshot chorioretinopathy and the white dot syndromes: do they exist? J Ophthalmol 2014; 2014:146768. [PMID: 24678412 PMCID: PMC3941241 DOI: 10.1155/2014/146768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/19/2013] [Accepted: 12/21/2013] [Indexed: 11/24/2022] Open
Abstract
Inflammatory conditions that affect the posterior pole are diverse. Specifically, birdshot chorioretinopathy and the white dot syndromes present with multiple white dots in the fundus. These diseases appear to affect similar age groups but there is question as to whether or not a difference exists between the genders. This review summarizes the current studies on birdshot chorioretinopathy and the white dot syndromes as they are related to gender, exploring the differences, if any, which may exist between prevalence, clinical presentation, and treatment response for these diseases. Though the specific etiology of these diseases remains unclear, future treatments may be guided as to how these diseases affect the sexes differently.
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Campos J, Campos A, Beselga D, Mendes S, Neves A, Sousa JPC. Punctate inner choroidopathy: a clinical case report. Case Rep Ophthalmol 2013; 4:155-9. [PMID: 24163685 PMCID: PMC3806698 DOI: 10.1159/000355389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose To report an uncommon case of a 29-year-old Caucasian male diagnosed with unilateral choroidal neovascularization (CNV) secondary to punctate inner choroidopathy leading to visual impairment. Methods This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of ancillary diagnostic tests. Results A 29-year-old Caucasian male presented to our emergency department with complaints of decreased central vision in his left eye (LE), detected a few hours before. Best-corrected visual acuity (BCVA) in the LE was counting fingers at 50 cm and BCVA in the right eye was 20/20. Fundoscopy of the LE evidenced multiple round and yellowish lesions in the macula and nasal to the optic nerve, without intraocular inflammation signs. Optical coherence tomography showed increased retinal thickness with detachment of the neuroepithelium and a slight retinal pigment epithelium detachment. Fluorescein angiography revealed hyperfluorescent lesions with blurred borders in the macula. An intravitreal injection of bevacizumab (1.25 mg/0.05 ml) was administered in the LE, which resulted in anatomic and visual improvement. Conclusion We present a rare case of unilateral CNV secondary to punctate inner choroidopathy in a young, myopic male.
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Affiliation(s)
- Joana Campos
- Ophthalmology Department, Leiria-Pombal Hospital Center, Leiria, Portugal
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Acute Zonal Occult Outer Retinopathy: Vision Loss in an Active Duty Soldier. Case Rep Med 2013; 2013:240607. [PMID: 23606850 PMCID: PMC3625598 DOI: 10.1155/2013/240607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/21/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022] Open
Abstract
Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient.Methods. In this paper we studied fundus photographs, optical coherence tomograph, Humphrey visual field 30-2, fundus autofluorescence images, fluorescein angiograms, and electroretinography.Results. Exam findings on presentation: a 34-year-old American Indian female presented with bilateral photopsias, early RPE irregularity, and an early temporal visual field defect. Progression RPE damage and visual field defect along with ERG findings support final diagnosis of AZOOR.Conclusion. AZOOR may initially be identified as a broader category of disease called the “AZOOR complex of disorders”. Specific visual field defects, ERG results, and clinical exam findings will help distinguish AZOOR from other similar disorders.
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Tsai CB, Tan CY, Yang PM, Chang KP. Bevacizumab treatment for choroidal neovascularization in a patient with chorioretinopathy resembling presumed ocular histoplasmosis syndrome. Taiwan J Ophthalmol 2012. [DOI: 10.1016/j.tjo.2012.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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INTRAVITREAL BEVACIZUMAB AS PRIMARY TREATMENT OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO PUNCTATE INNER CHOROIDOPATHY. Retina 2012; 32:1106-13. [PMID: 22481479 DOI: 10.1097/iae.0b013e318242b9da] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Characterization of macular lesions in punctate inner choroidopathy with spectral domain optical coherence tomography. J Ophthalmic Inflamm Infect 2012; 2:113-20. [PMID: 22210152 PMCID: PMC3438299 DOI: 10.1007/s12348-011-0054-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 11/21/2011] [Indexed: 11/02/2022] Open
Abstract
PURPOSE Punctate inner choroidopathy (PIC) is an ocular inflammatory disease. Spectral domain optical coherence tomography (SD-OCT) allows detailed visualization of retinal and choroidal structures. We aimed to describe the retinal changes on SD-OCT associated with PIC lesions localized in the macula. METHODS Retrospective case series: PIC lesions not associated with choroidal neovascularization (CNV) and captured by macular SD-OCT scans were identified and characterized. RESULTS Twenty-seven PIC lesions from seven patients (eight eyes) were identified and classified into four categories according to disease activity and temporal changes. Among clinically inactive patients, two main patterns were noted on OCT: (1) retinal pigment epithelium (RPE) elevation with sub-RPE hyper-reflective signals and (2) localized disruption of outer retinal layers with choroid and Bruch's membrane (BM) generally spared. Clinically active patients demonstrated lesions with intact BM with RPE elevation that fluctuated with disease activity and sub-RPE hyper-reflective signals. Photoreceptor-associated bands on SD-OCT (PRs) were not visible during active disease, but returned to normal visibility when lesions were clinically stable. Seven lesions in patients without clinically detected activity demonstrated alteration of RPE elevation. CONCLUSION SD-OCT can provide detailed structural characteristics of PIC lesions. RPE elevation is noted in many lesions while BM and choroid are spared. Photoreceptor-associated bands on SD-OCT appear compressed during clinically active stages and are visible during stabilization. OCT may provide information on activity not detected clinically.
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Zaharova E, Sherman J. The use of SD-OCT in the differential diagnosis of dots, spots and other white retinal lesions. Eye Brain 2011; 3:69-80. [PMID: 28539776 DOI: 10.2147/eb.s23208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To demonstrate the utility of a retinal imaging technique using spectral domain optical coherence tomography (SD-OCT) for creating a B-scan layer-by-layer analysis to aid in the differential diagnosis of various retinal dots, spots, and other white lesions. DESIGN Review. METHODS A retrospective review of imaging studies performed with SD-OCT (Topcon, 3DOCT-2000, Oakland, NJ) at SUNY State College of Optometry. RESULTS B-scan layer-by-layer analysis and unique SD-OCT reflectivity patterns of the following retinal white lesions are reviewed in the order of their retinal layer localization: myelinated nerve fiber layer, cotton wool spot, exudates, edema residues, drusen, fundus albipunctatus, Stargardt disease, Bietti crystalline dystrophy, punctate inner choroidopathy (PIC), presumed ocular histoplasmosis syndrome (POHS), post-photocoagulation chorioretinal scarring, and osseous choristoma. CONCLUSION The reviewed images demonstrate the utility of SD-OCT in the identification of the unique characteristics of the presented retinal pathologies. SD-OCT is ideal for retinal layer localization of lesions, thus enhancing the differential diagnosis of retinal dots, spots, and other white lesions. Even though true pathognomonic patterns are rare, highly suggestive findings of certain retinal abnormalities often facilitate immediate recognition and diagnosis.
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Affiliation(s)
- Elena Zaharova
- State University of New York's State College of Optometry, University Eye Center, New York, NY, USA
| | - Jerome Sherman
- State University of New York's State College of Optometry, University Eye Center, New York, NY, USA.,SUNY Eye Institute, New York, NY, USA.,New York Eye Institute and Laser Center, New York, NY, USA
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Chen FK, Tufail A. Multifocal outer retinopathy in a patient with multifocal inner choroidopathy. Clin Exp Ophthalmol 2011; 39:700-3. [DOI: 10.1111/j.1442-9071.2011.02525.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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