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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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Arrevola L, Acero MA, Peral MJ. Two-Year Outcome of Aflibercept for the Treatment of Choroidal Neovascularization in Punctate Inner Choroidopathy. Case Rep Ophthalmol 2019; 10:24-31. [PMID: 31043958 PMCID: PMC6477474 DOI: 10.1159/000496143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/09/2018] [Indexed: 11/19/2022] Open
Abstract
Punctate inner choroidopathy (PIC) is a rare inflammatory chorioretinopathy that predominantly affects young myopic women. Visual prognosis is generally good, but occurrence of choroidal neovascularization (CNV) is common and may be vision threatening. Case reports and short case series support the effectiveness of intravitreal anti-vascular endothelial growth factor (VEGF) agents (ranibizumab and bevacizumab) for CNV associated with PIC given their anti-angiogenic and anti-inflammatory effects. Evidence concerning aflibercept, a more recent intravitreal anti-VEGF, is limited to a single case report. In this case report, we illustrate the case of a 43-year-old myopic woman presenting with visual acuity loss and distortion in the right eye over the last 5 days in whom CNV associated with PIC was diagnosed. Treatment with 1 injection per month of intravitreal aflibercept for 2 months and full-dose oral prednisone for 1 week, being tapered afterwards, improved visual acuity and resolved CNV, with benefits lasting up to 24 months.
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