OCT 17, 2013
The authors of this small retrospective case series evaluated the characteristics of multifocal choroiditis and panuveitis (MCP) and punctate inner choroidopathy (PIC) using multimodal imaging and found them to be so similar that there was limited clinical utility in trying to differentiate them.
They found that despite the disease names, the principle sites involved appear to be the subretinal pigment epithelium and outer retinal spaces. The diseases target the same essential structures in the same phenotypic manner and, when active, are treated the same way. The authors further conclude that based on multimodal imaging results, a reappraisal of pathogenic features and naming conventions of these diseases seems indicated.
This article has wonderful images and should be in the files (electronic or otherwise) of any physician who sees or may see patients with PIC or MCP. It supplies further evidence of what has become more clear over the last couple of decades: MCP and PIC are related processes and are inflammatory.
The study included 38 eyes of 22 patients with MCP and/or PIC. Interestingly, seven patients had features of MCP in one eye and PIC in the other. While this has been observed before, finding it in one-third of the patients is a strong indication that these are overlapping processes, the difference being the presence of inflammatory cells in the vitreous in MCP. Most eyes with MCP did not have vitreous cells by clinical biomicroscopy; the cells were seen only on ocular coherence tomography (OCT), suggesting that many would have been classified as PIC.
The age of the patients, visual acuities and proportion of eyes with choroidal neovascular membranes did not differ between MCP and PIC. Both MCP and PIC active lesions responded to treatment with corticosteroids or steroid sparing immunomodulatory agents. Five patients had recurrences on tapering of corticosteroids that responded to an increase in dose, further evidence of the inflammatory nature of these lesions.
Choroidal neovascular membranes were very common, found in two-thirds of MCP eyes and half of PIC eyes, a difference that was not statistically significant, and were treated with agents against vascular endothelial growth factor.