By J. Fernando Arevalo, MD FACS
The authors of this retrospective study described the clinical course of all patients with punctate inner choroidopathy (PIC) referred to their tertiary center over a 10-year period. They found a high rate of choroidal neovascularization (CNV) and CNV recurrence. With aggressive immunosuppressive therapy, all patients had good visual results in at least one eye.
Of the 12 patients in this series, 75 percent had CNV, and more than 30 percent developed multiple neovascular membranes. Eight had CNV at initial presentation and one later developed CNV. Of the eight patients with an average follow-up of four years, five had CNV at initial presentation and five developed new CNV. Four had multiple CNV membranes.
Average age at presentation was 32 years (range, 24-52 years). Eleven were women, and 11 were white. Ten of the 11 patients with available refractive data were myopic. Treatment ranged from oral immunosuppression to intravitreal injection.
There is no standard protocol for the treatment of CNV in chorioretinal diseases such as PIC. Available options include systemic corticosteroids, intravitreal triamcinolone acetonide, photodynamic therapy, and lately anti-VEGF therapy. Because the study included few patients that received each of the therapies, the authors refrained from commenting on the efficacy of one treatment option over another.
They did note that patients with PIC and CNV should be offered intravitreal anti-VEGF therapy and local corticosteroid therapy. Patients with multiple recurrences may need maintenance systemic therapy with immunosuppressive medications.
All six patients with a follow-up of ≥ 3 years had visual acuity at three years post-presentation of > 20/40 in at least one eye, and four had visual acuity > 20/40 bilaterally.
The authors say the high rate of CNV occurrence in this study, which is at the upper end of the reported spectrum of 27 percent to 77 percent, may be due to the relatively extended follow up. Other limitations include the study's retrospective nature, referral bias, and small sample size. It is also notable that these patients were referrals to a tertiary center. Thus, asymptomatic patients with PIC likely exist and the reported 75 percent incidence rate of CNV may not apply to the real world.