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Dominika Pohlmann, Uwe Pleyer, Antonia M Joussen, Sibylle Winterhalter; Immunosuppressants and/or Anti-Vascular Endothelial Growth Factor inhibitors in Punctate Inner Choroidopathy? Follow-up Results with Optical Coherence Tomography Angiography. Invest. Ophthalmol. Vis. Sci. 2018;59(9):423.
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There is no evidence for a gold standard treatment for patients with punctate inner choroidopathy (PIC). Patients are treated with corticosteroids, steroid-sparing immunosuppressants, and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) inhibitors in case of choroidal neovascularization (CNV). We performed a prospective, single-center study to elevate retinal and choroidal changes of punctate lesions and CNV in PIC using standard imaging modalities and optical coherence tomography angiography (OCTA).
Twenty-three individuals with PIC underwent imaging with spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), indocyanine green angiography (ICGA), and OCTA. In case of lesion/CNV activity on SD-OCT and FA/ICGA, anti-VEGF injections were carried out. The examinations were conducted during a 20 months-follow-up. Kruskal-Wallis, Wilcoxon, and Mann-Whitney-U-test were used for statistical analysis.
Thirty-seven eyes of 23 patients were affected. Twenty-one patients were female (91%, 21/23), and the mean age of all individuals on the date of data collection was 46 +/- 11 years (range 26-64). Nine (24%) eyes revealed typical punctate lesions, while 28 (76%) eyes had confirmed CNV in addition to punctate lesions. Patients without immunosuppressants (52%, 12/23) showed a significant reduction of lesion/CNV size (p=0.0078), as well as a decrease of fluid retention (p=0.0078) on OCTA after anti-VEGF injection. Patients with immunosuppressants in combination with anti-VEGF injections (48%, 11/23) did not demonstrate any significant reduction of lesion/CNV size, vessel shape, or fluid retention post-injection. But overall, fluid accumulation was significantly lower in patients with immunosuppressants (median=0.03 mm2) in comparison to patients without immunosuppressants (median=0.32 mm2) (p=0.0028).
Anti-VEGF inhibitors are necessary to reduce fluid retention in PIC patients. However, immunosuppressants in addition to anti-VEGF injections showed a significant reduction of fluid accumulation in the follow-ups i.e. reduced disease activity. OCTA also provides an excellent tool for three-dimensionally measuring of lesion/CNV size, vessel shape, and fluid retention. This imaging technique is therefore useful for analysis of disease activity.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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