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R. Channa, P. Turkcuoglu, M. Ibrahim, E. Hatef, Z. Rentiya, J. Wang, A. Khwaja, S. Shah, D. Do, Q. D. Nguyen; Characterization of Lesions in Punctate Inner Choroidopathy With Spectral Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6378.
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Punctate inner choroidopathy (PIC) is an ocular inflammatory disease mostly affecting young women. It may lead to severe visual loss with development of subretinal fibrosis and choroidal neovascularization (CNV). Spectral domain optical coherence tomography (SD-OCT) allows detailed visualization of retinal and choroidal structures. We describe the characteristics of PIC lesions at various stages employing SD-OCT.
SD-OCT (SpectralisTM) patterns of 7 patients (7 eyes) with PIC were systematically reviewed. Six patients had scans available for multiple visits, with length of follow-up ranging from 4 to 36 months; one patient was scanned only once. PIC lesions not associated with CNV and within the grid of SD-OCT were selected. Criteria for activity of lesions included patient’s symptoms, presence of indistinct borders and surrounding edema on contact-lens biomicroscopy, and leakage on fluorescein angiography(FA).
We identified 22 lesions: 2 as clinically active and 20 as clinically stable. Among the 20 clinically inactive lesions, two main patterns were noted on OCT: (1) RPE elevation with sub-RPE collection of hyper-reflective substances; (2) no RPE elevation but localized disruption of outer retinal layers, including outer nuclear and outer plexiform layers and photoreceptors; choroid and Bruch’s membrane were generally spared. Clinically active lesions demonstrated intact Bruch’s membrane with elevation of the RPE which decreased with lessened disease activity, and sub-RPE deposition of hyper-reflective substances. Photoreceptors were not visible during active disease, but returned to normal structure with clear visibility when the lesion was found to be clinically stable. Seven lesions, judged to be clinically stable with no activity on FA and clinical examination, demonstrated alteration of RPE elevation, suggesting ongoing sub-clinical activity.
SD OCT can provide detailed structural characteristics of PIC lesions. RPE elevation is noted in many lesions while Bruch’s membrane and choroid are spared. Photoreceptors appear compressed during clinically active stages and return to normal structure with clear visibility during stabilization. OCT may provide information on activity not detected clinically. Further systematic OCT studies of PIC lesions are indicated to provide additional insights about clinical course of PIC.
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