Punctate Inner Choroidopathy (PIC)
Title: Punctate Inner Choroidopathy (PIC)
Author: Sai Bhuvanagiri (MS IV); Akbar Shakoor, MD
Photographer: Photo courtesy of Dr. Shakoor
Financial Disclosure: None
Image: SD-OCT of images of Active Punctate Inner Choroidopathy (above) with Choroid Neovascular Membrane complication and Inactive Punctate Inner Choroidopathy lesion (below)
Keyword/ Main Subject: SD-OCT images of Active Punctate Inner Choroidopathy (PIC) with complication of Choroidal Neovascular Membrane (CNV) (above) and bottom image of lnactive Punctate Inner Choroidapthy of the same patient after appropriate anti-VEGF treatment
Diagnosis/ Differential Diagnosis: Punctate Inner Choroidopathy, Multiple Evanescent White Dot Syndrome, Multiple Choroiditis, Presumed Ocular Histoplasmosis Syndrome, Birdshot’s Retinopathy
Brief Description: Punctate Inner Choroidopathy (PIC) is a very rare ocular inflammatory disease considered to be part of the White Dot syndromes that fall under the umbrella of uveitis. PIC frequently affects young Caucasian myopic women with mostly bilateral involvement 2.
Patients present with symptoms of loss of central visual acuity (VA), photopsia and central scotoma. PIC is usually a benign disease; however, visual loss can occur secondary to complications of CNV or subretinal fibrosis. The current etiology is unknown but is thought to have familiar predisposition to autoimmune/ inflammatory diseases with response against antigens in the outer retina and inner choroid and increase in choroidal thickness during acute phases of PIC and reduction during regression of PIC 4 • The mainstay of treatment for PIC is anti-VEGF intravitreal injections with mean visual acuity (VA) that returned from baseline of
3.2 /10 to 6/10 in 12 months with no disease recurrence 6. Other treatment option includes oral steroids with VA return from baseline of 1/10 to 6.7/10 in a week 5. However, they are not the primary form of treatment due to systemic side effects. Other treatment options include mycophenolate mofetil, laser photocoagulation, and submacular surgery 1.
When this patient was diagnosed with PIC, she initially presented with central vision loss in the right due to CNVM. On further investigation of patient’s history and ruling out infectious causes, the patient was found to have PIC. The main factors that lead to the diagnosis of PIC are patient’s acute symptoms, patient’s demographic correlation to similar patients with PIC, lack of anterior chamber inflammation and SD-OCT image (above) finding of RPE elevation with a loss of photoreceptor (PR) layer 3. The patient was treated with Avastin (anti-VEGF) intravitreal injections with week duration to treat both CNVM and PIC. The patient is followed every three months and had no recurrences so far for the past nine months. The latest SD-OCT image confirms the resolution of the patient’s active PIC phase with re-appearance of her PR layer and reduced RPE layer elevation 2.
Identifier: Moran_CORE_ 21453
- Campos J, et al. “Punctate Inner Choroiditis” Innovations in Ophthalmology. October, 2014.
- Channa R, et al. “Characterization of macular lesions in punctate inner choroidopathy with spectral domain optical coherence tomography “Journal of Ophthalmic Inflammations and Infections. July, 2012.
- Goldstein D, et al. “Multifocal Choroiditis vs. PIC: Variations on a Theme”.
Ophthalmology Review, July, 2004.
- Hiraoka K, et al. “Increased macular choroidal blood flow velocity and decreased choroidal thickness with regression of punctate inner choroidopathy “BMC Ophthalmology. May, 2014.
- Olsen TW, Capone A, Sternberg P, et al. Subfoveal choroidal neovascularization in punctate inner choroidopathy. Surgical management and pathologic findings. Ophthalmology. 1996.
- Zhang X, Wen F, Zuo C, Li M, Chen H, Huang S, Luo G. Clinical features of punctate inner choroidopathy in Chinese patients. Retina.