Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin
Commercial Relationships: S.S. Bhatt, None; J. Rha, None; J. Carroll, None; K. Stepien, None.
Support: Research to Prevent Blindness
Purpose:Punctate Inner Choroidopathy (PIC) is a rare, presumably inflammatory condition involving the outer retinal layers. Here we sought to evaluate photoreceptor structure in PIC using Spectral Domain Optical Coherence Tomography (SD-OCT) and Adaptive Optics (AO) retinal imaging.
Methods:A young myopic female patient was found to have central scotomas, photopsias, and blurred vision. Fundus exam demonstrated punched out lesions, 100-300 microns in size isolated to the posterior pole without evidence of vitritis. Imaging with autofluorescence, fluorescein and indocyanine green angiography further supported the diagnosis of PIC. Over the course of a few weeks, two new lesions were identified clinically and on imaging. One of these lesions developed a choroidal neovascular membrane (CNVM) which was successfully treated with bevacizumab. Scans, at multiple visits, were obtained through the macula using Spectralis SD-OCT (Heidelberg, Heidelberg Germany) as well as Bioptigen SD-OCT (Bioptigen, Raleigh, NC). Additional images in the parafoveal region were obtained with adaptive optics ophthalmoscopy.
Results:SD-OCT images of inactive lesions demonstrated irregular thickening of the retinal pigment epithelium (RPE), loss of the overlying photoreceptor inner segment/outer segment (IS/OS) junction, and disruption of the outer nuclear layer. SD-OCT of active lesions demonstrated disruption with thickening at the level of the RPE and the photoreceptor IS/OS junction with overlying intraretinal cystic changes, resulting in a focal increase in retinal thickness at the area of the lesion. One active lesion developed a CNVM that showed focal elevation of the RPE and retinal thickening with adjacent intraretinal fluid on SD-OCT. These findings resolved after treatment with bevacizumab. In the AO images, normal cone topography was observed in areas surrounding the lesions, however we were unable to resolve cone structure overlying the lesion.
Conclusions:The ability to evaluate the pathology of PIC on a structural and cellular level provides the opportunity to monitor disease progression and activity as well as therapeutic response to treatment of CNVMs.
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