Dec 23, 2018 what are the causes of punctate inner choroidopathy. It debuts with multiple roundish lesions of atrophic appearance located in the posterior pole at the level of the. We aimed to describe the retinal changes on sdoct associated with pic lesions localized in the macula. Fundus photographs demonstrating choroidal lesions associated with punctate inner choroidopathy. The purpose of this study was to describe a combination treatment for choroidal neovascular cnv membrane.
Characterization of macular lesions in punctate inner. Pic is an infrequent ocular inflammatory disease, frequently affecting young myopic women. The aim of this study was to quantitatively evaluate changes in choroidal blood flow velocity by using laser speckle flowgraphy lsfg in patients with pic. A diagnosis of pic was made by two experienced retinal. Punctate inner choroidopathy pic is a rare, idiopathic, inflammatory disease confined to the inner choroid and retinal pigment epithelium that occurs in otherwise healthy, predominantly young adult myopic women. Myopic macular degeneration myopia itself is a common disorder resulting from excessive lengthening of the eye which causes shortsightedness. Spectral domain optical coherence tomography sdoct allows detailed visualization of retinal and choroidal structures. J ophthal inflamm infect surgical management and ultrastructural study of choroidal neovascularization in punctate inner choroidopathy after bevacizumab sophia i.
Punctate inner choroidopathy recurrent cnvm 4 years after initial treatment left eye indocyanine green angiogram 128 views june 7, 2012. Punctate inner choroidopathy pic is characterized by multiple small lesions in the macula without an associated intraocular inflammatory response. Management of uveitisrelated choroidal neovascularization. To evaluate the efficacy and safety of combined intravitreal triamcinolone ivta and photodynamic therapy pdt with verteporfin in the treatment of subfoveal choroidal neovascularization cnv due to punctate inner choroidopathy pic or of idiopathic cause. This means that instead of fighting off bugs, the immune system also starts to. It is a form of uveitis, a term used to describe a number of conditions which are characterised by inflammation within the eye. Intravitreal bevacizumab appears safe for pregnant women. Feb 28, 20 fundus photo following treatment with bevacizumab in a 31yearold female with vision loss from a choroidal neovascular membrane cnv from punctate inner choroidopathy. Punctate inner choroidopathy, choroidal neovascularization, intravitreal bevacizumab introduction the term punctate inner choroidopathy pic was first used by watzke et al. This is a brief description of pic from a 2005 issue of the canadian j of ophthalmology. Intravitreal bevacizumab for choroidal neovascularisation. I have received avastin injections since march 2007 and there was some progress, but the massgrowth has manifested itself and is now larger in july 2007 than it was in march 2007. In the series by chan et al, the 4 patients with pic treated with 3 bevacizumab. This pleasant 35yearold woman noticed decreasing vision in the left eye recently.
Choroidal neovascular membranes cnv are the major cause of visual loss in punctate inner choroidopathy pic, an idiopathic inflammatory condition predominantly affecting young, myopic women. Punctate inner choroidopathy pic is an idiopathic chorioretinitis with a predilection for young myopic women. A pregnant woman diagnosed with choroidal neovascularization cnv secondary to punctate inner choroidopathy was treated with verteporfin and bevacizumab, without fetal side effects. Serous retinal detachment suggestive of cnv was also observed od fig. Direct and indirect laser photocoagulation of central serous choroidopathy.
Jul 01, 2017 intravitreal bevacizumab avastin for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin. Its pathogenesis is supposed to be similar to the wet age related macular degeneration. Pic is an infrequent ocular inflammatory disease, mostly affecting young myopic women. Twoyear outcome of aflibercept for the treatment of choroidal. Intravitreal bevacizumab avastin for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin author links open overlay panel waiman chan a b c timothy y. Consecutive patients with subfoveal idiopathic and pic cnv were prospectively recruited and received combined pdt and. Cscr typically occurs in males in their 20s to 50s who exhibit acute or subacute central vision loss or distortion. Punctate inner choroidopathy pic is a relatively uncommon idiopathic inflammatory multifocal chorioretinopathy, which occurs at the level of the outer retina, retinal pigment epithelium rpe. Macula retina vitreous center torrance location 23451 madison st.
Although occurring rarely, choroidal neovascularisation from punctate inner choroidopathy picr constitutes a clinical entity of some relevance particularly since the. Punctate inner choroidopathy pic is an infrequent endogenous posterior uveitis included in the white spots syndrome and first described in 1984 by watzke et al. Punctate inner choroidopathy pic is a rare inflammatory. What are the symptoms of central serous choroidopathy. Although currently submacular translocation surgery is. The term punctate inner choroidopathy pic was first used by watzke et al 1 in 1984 to describe findings in a group of 10 patients with multifocal, wellcircumscribed, usually small choroidal lesions. Apr 01, 2008 intravitreal bevacizumab for choroidal neovascularisation secondary to punctate inner choroidopathy intravitreal bevacizumab for choroidal neovascularisation secondary to punctate inner choroidopathy vossmerbaeumer, urs. This study aims to describe surgical management results and the pathologic features of choroidal neovascularization cnv secondary to punctate inner choroidopathy pic following antivascular endothelial growth factor treatment. Punctate inner choroidopathy pic is a very rare ocular. Uveitis information group punctate inner choroidopathy. Intravitreal bevacizumab for offlabel ocular indications appeared safe and effective in pregnant patients with choroidal neovascularization unrelated to agerelated macular. Symptoms include blurred central vision, small image size micropsia, and distortion of the image metamorphosia. Changes in the mean logmar bestcorrected visual acuity bcva following intravitreal bevacizumab avastin for the treatment of idiopathic choroidal neovascularization cnv and cnv secondary to central serous chorioretinopathy or punctate inner choroidopathy.
Visual and optical coherence tomography outcomes of. Punctate inner choroidopathy pic lesions tend to be smaller than those of multifocal choroiditis with panuveitis, with a higher frequency of developing choroidal neovascularization cnv. Punctate inner choroiditis pic is an inflammatory choroiditis which occurs mainly in young. Increased macular choroidal blood flow velocity and decreased choroidal thickness with regression of punctate inner choroidopathy bmc ophthalmology. It may be the result of a viral infection caused by epsteinbarr virus ebv, but this is not conclusively proven yet. Punctate inner choroidopathy pic is a specific form of posterior uveitis, firstly. Punctate inner choroidopathy pic is characterised by similar multifocal choroiditis lesions and cnv, except that there is an absence of intraocular inflammation and that the disease is preponderant among younger myopic females. Punctate inner choroidopathy pic is an inflammatory disease affecting the choroid and retina which can lead to vision loss, often in young women.
Choroidal neovascularization cnv is an important cause of visual impairment and may develop from more than 30 ocular diseases. My retinal specialist thinks it is punctate inner choroidopathy pic. It is more common in women, and in shortsighted people. Pic was first described in 1984 in a series of ten women by watzke et al. Exposure to verteporfin and bevacizumab therapy for. The condition is characterized by multiple punctate yellowwhite chorioretinal lesions that present mainly in the posterior pole of the retina. Intravitreal bevacizumab avastin for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin. Multifocal choroiditis panuveitis 32yearold woman cnvm. The term punctate inner choroidopathy pic was first used by watzke et al. Jan 15, 2019 the diseases that constitute the white dot syndromes include acute posterior multifocal placoid pigment epitheliopathy apmppe, serpiginous choroiditis, multiple evanescent white dot syndrome mewds, multifocal choroiditis and panuveitis mcp, punctate inner choroidopathy pic, and diffuse subretinal fibrosis dsf. Over 90% of pic is observed in individuals with myopia or near vision. Jul 11, 2008 a pregnant woman diagnosed with choroidal neovascularization cnv secondary to punctate inner choroidopathy was treated with verteporfin and bevacizumab, without fetal side effects. Full text combined treatment in punctate inner choroidopathy tcrm. Punctate inner choroidopathy pic is a rare condition caused by inflammation at the back of the eye.
We do not fully understand what causes pic, although there is some evidence that it may be an autoimmune condition. Punctate inner choroiditis pic is an inflammatory choroiditis which occurs mainly in young women. She returns now noticing the vision in the left eye is declining. Treatment of punctate inner choroidopathy with choroidal neovascularization using corticosteroid. Bevacizumab, choroidal neovascularization, electron microscopy, light microscopy, punctate inner choroidopathy, submacular surgery introduction punctate inner choroidopathy pic is an idiopathic disorder representing one point on a spectrum of the multifocal choroiditides. The disease is bilateral and most frequently diagnosed in moderately myopic females who report blurred vision, photopsias, and paracentral scotomata.
Marie tsaloumas is consultant ophthalmologist with special interest in diseases of the retina, including punctate inner choroidopathy pic. Classically, pic presents in young myopic women who complain of metamorphopsia and decreased visual acuity. Punctate inner choroidopathy pic is an ocular inflammatory disease. Inflammatory choroidal neovascularization is a severe but uncommon complication of uveitis, more frequent in posterior uveitis such as punctate inner choroidopathy, multifocal choroiditis, serpiginous choroiditis, and vogtkoyanagiharada syndrome.
Punctate inner choroidopathy pic is a rare form of posterior uveitis. Yellow lesions are mainly present in the posterior pole and are between 100 and 300 micrometres in size. Surgical management and ultrastructural study of choroidal. In the posterior pole, there are typical small creamy yellow lesions of the inner choroids and pigment epithelium, without. Active lesions of pic in the posterior pole of a 29yearold caucasian woman. Punctate inner choroidopathy also known as punctate inner choroiditis or pic for short is a rare chronic disease in which inflammation occurs in the sensitive sightenabling structures at the back of the eye. What are the causes of punctate inner choroidopathy. Avastin and lucentis are equivalent in treating age. Purpose punctate inner choroidopathy pic is an ocular inflammatory disease.
This study is a case report on the surgical management and ultrastructural study of choroidal neovascularization. May 28, 2014 changes in choroidal circulation hemodynamics during the course of punctate inner choroidopathy pic remain unknown. Punctate inner choroidopathy was defined as the presence of multifocal, pale, atrophic lesions at the level of the retinal pigment epithelium and inner choroid in the absence of any sign of inflammation elsewhere in the eye ie, vitritis, pars planitis, anterior chamber cells, or anterior synechiae. The term punctate inner choroidopathy pic was first used by watzke et al in 1984. Spectral domain optical coherence tomography demonstrated extensive attenuation of the external limiting membrane, ellipsoid and interdigitation zones, adjacent to the visible multifocal choroiditispunctate inner choroidopathy lesions. The level of myopia is measured in dioptres d, people who are mildly shortsighted are likely to have a measurement of 0. Punctate inner choroidopathy is often confused with multifocal choroiditis. Chan wm, lai ty, liu dt, lam ds 2007 intravitreal bevacozimab avastin for choroidal neovascularization secondary to central serous choroidopathy, secondary to punctate inner choroidopathy, or of idiopathic origin. Punctate inner choroidopathy with cnv treated with. To report acutesubacute vision loss and paracentral scotomata in patients with idiopathic multifocal choroiditis punctate inner choroidopathy due to large zones of acute photoreceptor attenuation surrounding the chorioretinal lesions. It debuts with multiple roundish lesions of atrophic appearance located in the. Oct 26, 2010 intravitreal bevacizumab for offlabel ocular indications appeared safe and effective in pregnant patients with choroidal neovascularization unrelated to agerelated macular pathologies, a study.
Punctate inner choroidopathy pic also has a predilection for myopic female patients, but it tends to affect somewhat younger patients, with a mean age of onset of 26 years range 1640 years. Laser speckle flowgraphy, punctate inner choroidopathy background punctate inner choroidopathy pic is an idiopathic chorioretinitis with a predilection for young myopic women. Pic lesions not associated with choroidal neovascularization cnv and. Mfc patients may present with symptoms of posterior uveitis including decreased visual acuity, floaters, photopsias, as well as with anterior segment symptoms such as photophobia. Pic is one of the so called white dot syndromes which come under the heading posterior uveitis. The diseases that constitute the white dot syndromes include acute posterior multifocal placoid pigment epitheliopathy apmppe, serpiginous choroiditis, multiple evanescent white dot syndrome mewds, multifocal choroiditis and panuveitis mcp, punctate inner choroidopathy pic, and diffuse subretinal fibrosis dsf. Chan wmlai tyliu dtlam ds intravitreal bevacizumab avastin for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin. Sep 28, 20 the term punctate inner choroidopathy pic was first used by watzke et al. The lesions involve retinal pigment epithelium and deeper layers of the choroid. Combined treatment in punctate inner choroidopathy barbara terelakborys, katarzyna zagajewska, irmina jankowskalech, piotr tesla, iwona grabskaliberek department of ophthalmology, centre of postgraduate medical education, prof w orlowski clinical hospital, warsaw, poland purpose. Treatment of punctate inner choroidopathy with choroidal. Punctate inner choroidopathy picr is an inflammatory disorder of the choroid at the posterior pole of the eye that occurs predominantly in female patients with moderate myopia during the second to fourth decade of life.
The term punctate inner choroidopathy pic was first used by watzke, et al. This pic patient was initially treated with systemic corticosteroids for 4 months. Patients have little to no anterior segment or vitreous inflammation. Increased macular choroidal blood flow velocity and. Central serous choroidopathy is a disease that causes fluid to build up under the retina. Subfoveal choroidal neovascularization in punctate inner choroidopathy. These lesions appeared to be located at the level of the choroid and retinal pigment epithelium rpe. Punctate inner choroidopathy pic was first described by watzke in 1984. Jakobiec 0 1 2 pooja bhat 0 1 2 lucia sobrin 0 1 2 norman a. Combined photodynamic therapy with intravitreal triamcinolone seems to be a promising treatment strategy in the treatment of idiopathic choroidal neovascularization cnv and cnv secondary to punctate inner choroidopathy as it resulted in fewer treatment sessions and superior visual improvement. Pdf treatment of punctate inner choroidopathy with choroidal. The condition is characterized by multiple punctate yellowwhite chorioretinal lesions that present mainly in the posterior pole of the retina 14. These lesions were said to variably evolve into hypopigmented scars, pigmented scars, or hyperplastic fibrotic scars as a result of choroidal neovascularization cnv. May 15, 2008 intravitreal bevacizumab avastin for choroidal neovascularization secondary to central serous chorioretinopathy, secondary to punctate inner choroidopathy, or of idiopathic origin.
Multifocal choroiditis mc is a chronic inflammatory disease that most frequently occurs in women who have myopia and are in the third to fifth decade of life. Etiology punctate inner choroidopathy is a rare eye condition of unknown cause. At two years, avastin bevacizumab and lucentis ranibizumab injection, two widely used drugs to treat agerelated macular degeneration amd, improve vision when administered monthly or on an as needed basis, although greater improvements in vision were seen with monthly administration for this common, debilitating eye disease, according to researchers supported by the. We present a case series of 9 patients with cnv associated with pic, treated with intravitreal antivascular endothelial growth factor agents. Combined treatment in punctate inner choroidopathy ncbi. Pic has only been recognised as a distinct condition, or type of posterior uveitis, as recently as 1984 when watzke identified 10 patients who appeared to make up a. The vision improved and was stable following a single injection.
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