We have read the whole case report with great interest. We would like to congratulate Rao et al., for such a rare presentation. We have few comments regarding the case report, and these are as follows:
- Bilateral Choroidal Neovascular Membrane (CNVM) at 28 years with recurrent history of abortion – most likely inflammatory CNVM.
- At 28 years of age, whether pregnancy was ruled out. As, 5 months later, she came with threatened abortion – two causes: tuberculosis (TB)/infections (common in the Indian scenario) and complication of Photodynamic Therapy (PDT) and Lucentis (contraindicated).
- History of recurrent abortions – TB should have been ruled out.
- Criteria for punctate inner choroidopathy (PIC) is not well defined.
- Indocyanine Green Angiography (ICGA) could be better definining in this case.
We would like to suggest some criteria for PIC as written in the literature.
First described by Watzke and associates in 1984, PIC typically affects young, moderately myopic women who present with typical signs of ocular histoplasmosis but have negative serology or skin test for histoplasmosis. This rare condition is also one of the entities grouped under AZOOR. Other terms used to describe this condition include multifocal inner choroiditis and pseudohistoplasmosis. The average age of patients with PIC is 27 years, with a range of 16–40 years. Females represent 90% of the patients with PIC, and usually have bilateral ocular involvement.
The classic triad of punched-out peripheral lesions in association with peripapillary atrophic scar formation and disciform macular scar seen in Presumed Ocular Histoplasmosis (POHS) is often present in patients with PIC. Small serous retinal detachments may form; however, they resolve spontaneously and usually require no treatment. Both optic disc edema and presence of vitreous cells appears to be a variable finding in patients with PIC. The occurrence of subretinal neovascular membranes in this condition is 25–40%.
Dr. A. S. Guruprasad, M. M. Joshi Eye Institute, Hubli, Karnataka.
1. Rao VG, Rao GS, Narkhede NS. Flare up of choroiditis and choroidal neovasculazation associated with punctate inner choroidopathy during early pregnancy Indian J Ophthalmol. 2011;59:145–8
2. Morgan CM, Schatz H. Recurrent multifocal choroiditis Ophthalmology. 1986;93:1138–47
3. Watzke RC, Packer AJ, Fol JC, Benson WE, Burgess D, Ober RR. Punctate inner choroidopathy Am J Ophthalmol. 1984;98:572–84
4. Taira K, Nakazawa M, Takano Y, Ota T. Acute zonal occult outer retinopathy in the fellow eye 5 years after presentation of punctate inner choroidopathy Graefes Arch Clin Exp Ophthalmol. 2006;244:880–2