Spectral-domain optical coherence tomographic findings at each stage of punctate inner choroidopathy.

Abstract

PURPOSE:

To describe the natural course of punctate inner choroidopathy (PIC) using spectral-domain optical coherence tomography (SD-OCT).

DESIGN:

Prospective observational case series.

PARTICIPANTS:

Forty-two consecutive patients (60 eyes) with PIC with at least 3 months of follow-up.

METHODS:

Serial SD-OCT images were obtained from both eyes of each participant at each visit.

MAIN OUTCOME MEASURES:

The morphologic characteristics of each stage of PIC lesions observed by SD-OCT.

RESULTS:

Continued stage progression of PIC lesions was observed in 27 eyes (45%), among which choroidal thickness changes were observed in 8 eyes (30%). Stage I lesion showed a normal appearance or slight irregularities in the outer nuclear layer. Stage II lesion appeared as a focal elevation of the retinal pigment epithelium (RPE) with corresponding disruption of the inner and outer segments of the photoreceptor interface. Stage III lesion broke through the RPE, forming a hump-shaped chorioretinal nodule with moderate reflectivity beneath the outer plexiform layer (OPL), generally with subsequent disruption of Bruch's membrane. Nodules occasionally invaded the inner retina, causing segmental retinal phlebitis in 2 eyes. Stage IV lesion regressed in a retrograde manner with tissue loss from the photoreceptor layer and inner choroid, finally leaving a V-shaped hernia of the OPL and inner retina into the choroid. Stage V lesion gradually eliminated the photoreceptors around the lesion; this process was accompanied by RPE proliferation at multiple levels, which reduced retinal herniation. Parafoveal stage V lesions caused late occult macular atrophy in 4 eyes. Choroidal thickness increased throughout the active phase and reached a peak at stage III; this parameter then significantly decreased at stage IV and gradually reached a minimum that was lower than the initial value at stage I.

CONCLUSIONS:

Punctate inner choroidopathy is a chorioretinitis rather than an inner choroidopathy. Spectral-domain OCT characterized a 5-stage evolution of PIC lesions: choroidal infiltration, formation of sub-RPE nodules, and then chorioretinal nodules, regression, and retinal herniation.

• Authors: Xiongze Zhang, Chengguo Zuo, Meng Li, Hui Chen, Shizhou Huang, Feng Wen
• Journal: Ophthalmology (Ophthalmology) Vol. 120 Issue 12 Pg. 2678-2683 (Dec 2013) ISSN: 1549-4713 [Electronic] United States
• PMID: 23769333 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Child
• Chorioretinitis (classification, diagnosis)
• Choroid (pathology)
• Disease Progression
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Prospective Studies
• Retinal Photoreceptor Cell Inner Segment (pathology)
• Retinal Photoreceptor Cell Outer Segment (pathology)
• Retinal Pigment Epithelium (pathology)
• Tomography, Optical Coherence (methods)