The Effect of Mycophenolate Mofetil and Fundus Autofluorescence Characteristics During the Clinical Course of Patients With Punctate Inner Choroidopathy

Abstract

Purpose: : Corticosteroids have been used in punctate inner choroidopathy (PIC). Since the usage of immunomodulatory therapy (IMT), as steroid-sparing agent, is often required to maintain quiescence of ocular inflammation, we evaluated the effect of IMT with mycophenolate mofetil (MMF) on the clinical course of patients with recurrent PIC and described the fundus autofluorescence (FAF) characteristics in eyes with PIC.

Methods: : A review of 21 patients with PIC was conducted. 8 patients, who met all the following inclusion criteria: (1) at least two recurrent episodes of increased activities (indistinct borders and surrounding edema on contact-lens biomicroscopy and leakage on fluorescein angiography) of the PIC lesion(s) and/or choroidal neovascularization (CNV) before initiation of IMT; (2) 12 months of documented clinical course before IMT; and (3) 12 months of follow-up evaluations with full documentation in medical records after IMT, were employed for analyses of recurrences and stabilization. 7 patients (combination of active and stable PIC) had FAF images that were carefully reviewed for characterization.

Results: : The mean follow-up period of 8 patients before and after treatment with IMT was 38.37±24.60 and 37.25±21.55 months, respectively. Prior to IMT, the 8 patients experienced a total of 19 recurrent episodes (16 with CNV, 3 without CNV). During IMT, 3 (38%) patients experienced a total of 6 recurrent (4 with CNV, 2 without CNV) episodes. The frequencies of attacks (defined as number of attacks/year) were 1.09 ± 0.75 before and 0.16 ± 0.28 during treatment, respectively (p = 0.017), suggesting a statistically significant decrease of disease recurrences with IMT. Among the 7 patients who had FAF, hyperautofluorescent halo surrounding the PIC lesions was detected in 4. In 1 patient, the intensity of the hyperautofluorescence decreased after treatment; 2 patients did not demonstrate any changes in the intensity of FAF of their PIC lesions and experienced subsequent recurrence of disease while on IMT.

Conclusions: : Immunomodulatory therapy with MMF may provide long-term control and decrease frequency of recurrent attacks of disease or its complications (CNV) in patients with PIC. FAF might be employed to monitor and predict the response and/or future resistance to treatment.

Keywords: chorioretinitis • immunomodulation/immunoregulation • imaging/image analysis: clinical