April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Idiopathic multifocal choroiditis (MFC)/punctate inner choroidopthy (PIC) with acute photoreceptor loss out of proportion to clinically visible lesions
Author Affiliations & Notes
  • Marion Ronit Munk
    Dept of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, IL
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • Jesse J Jung
    Department of Ophthalmology, New York University School of Medicine, New York, NY
    Vitreous Retina Macula Consultants of New York, New York, NY
  • Kristin Biggee
    Department of Ophthalmology, Casey Eye Institute/Oregon Health and Science, Portland, OR
  • Ursula Schmidt-Erfurth
    Department of Ophthalmology, Medical University Vienna, Vienna, Austria
  • William R Tucker
    Department of Ophthalmology, National Eye Institute, National Institute of Health, Bethesda, MD
  • H Nida Sen
    Department of Ophthalmology, National Eye Institute, National Institute of Health, Bethesda, MD
    Department of Ophthalmology, THe George Washington University, Washington, WA
  • Amani A Fawzi
    Dept of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, IL
  • Lee M Jampol
    Dept of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, IL
  • Footnotes
    Commercial Relationships Marion Munk, None; Jesse Jung, None; Kristin Biggee, None; Ursula Schmidt-Erfurth, None; William Tucker, None; H Nida Sen, None; Amani Fawzi, None; Lee Jampol, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 2856. doi:
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      Marion Ronit Munk, Jesse J Jung, Kristin Biggee, Ursula Schmidt-Erfurth, William R Tucker, H Nida Sen, Amani A Fawzi, Lee M Jampol; Idiopathic multifocal choroiditis (MFC)/punctate inner choroidopthy (PIC) with acute photoreceptor loss out of proportion to clinically visible lesions. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2856.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To report 7 cases (8 eyes) of idiopathic multifocal choroiditis/punctate inner choroidopathy(MFC/PIC) with small discrete chorioretinal lesions surrounded by a larger zone of acute photoreceptor (PR) irregularity and loss.

 
Methods
 

A retrospective multimodal imaging case series

 
Results
 

6 females and 1 male were included (mean age at disease-onset 31.7±6.4, range 23-42 years). Visual acuity at presentation was as severe as hand-motion in the setting of widespread central vision and visual field loss, not explained by the ophthalmoscopically visible lesions. No vitreous cells were present. SD-OCT demonstrated extensive loss/irregularity of the ellipsoid zone, interdigitation zone and the external limiting membrane (ELM) not limited to the immediate location of the MFC/PIC lesions. The corresponding areas of PR loss were hyper-autofluorescent on blue (488nm) fundus autofluorescence (FAF) and near-infrared (788nm)-FAF, while the MFC lesions were hypo-autofluorescent. Indocyanine and fluorescein-angiogram showed only the MFC/PIC lesions. Scotomata detected in visual field testing corresponded to the areas of PR changes. In 4 cases a full-field ERG was performed, which showed a markedly decreased cone and rod response. Four patients were treated with oral corticosteroids, 1 patient with intravitreal triamcinolone and 2 patients additionally with intravitreal bevacizumab injections. The photoreceptor status improved in a single case only, while another case experienced worsening of the visual field defect/PR loss during the observational period.

 
Conclusions
 

MFC/PIC can present with secondary permanent or transient PR loss. Severity and extent of MFC-associated changes are best evaluated using a multimodal imaging approach. This dramatic presentation of PR-loss is likely a variant of MFC with chorioretinal atrophy, recently described by Jung et al.

 
 
Near-infrared (788nm)-FAF: Hyper-autofluorescent area correspond to the area of photoreceptor-loss in SD-OCT
 
Near-infrared (788nm)-FAF: Hyper-autofluorescent area correspond to the area of photoreceptor-loss in SD-OCT
 
 
SD-OCT reveals two active choroiretinal lesions surrounded by extensive loss/irregularity of the ellipsoid zone, the interdigitation zone and the external limiting membrane
 
SD-OCT reveals two active choroiretinal lesions surrounded by extensive loss/irregularity of the ellipsoid zone, the interdigitation zone and the external limiting membrane
 
Keywords: 451 chorioretinitis • 550 imaging/image analysis: clinical • 688 retina  
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