Punctate inner choroidopathy (PIC), first described by Watzke et al., in 1984, is a disease of young, relatively healthy, myopic women characterized by small yellow-white lesions of the inner choroid and retinal pigment epithelium (RPE). The chorioretinal lesions seen in PIC tend to be small and acutely no larger than 500 μm. Acute lesions heals to atrophic scars and develop more pigmentation with time. Choroidal neovascular membranes (CNVM) develops in more than half of these individuals. We describe a case of PIC occurring in a young adult male with CNVM. The clinical characteristics, fundus fluorescein angiography (FFA), and indocyanine green angiography (ICGA) findings are described.
A 31-year-old male patient presented to us with complaints of blurring of vision and floaters in left eye for past 1 year. His best corrected visual acuity was 20/20 in the right eye and 20/50 in the left eye. Anterior segment of both eyes were unremarkable. Fundus examination of the right eye was normal, and the left eye showed multiple grey lesions over the posterior pole with a partially scarred subfoveal CNVM [Fig. 1].
On FFA the lesions appear hyperfluorescent in the arterial phase [Figs. 2 and 3]. In later phases, the lesions stain [Fig. 4]. More lesions are seen on FFA than are clinically visible. On ICGA lesions were hypofluorescent in the early, middle, and late phases [Figs. 5–7]. Many more lesions are seen on ICGA than were clinically visible or seen in FFA. In the area of lesions larger choroidal vessels were seen crossing. He was started on oral steroids and received intravitreal ranibuzimab for the CNVM.
PIC is a rare inflammatory choroiditis; some believe multifocal choroiditis and PIC as spectrum of a single disease. Though it was first described in women, it has been reported in men as well. PIC is not associated with anterior or posterior segment inflammation. Although PIC is not associated with significant visible inflammation, the lesions respond well to immunosuppression; especially if associated with CNVM.
This case is reported for its rarity, unusual unilateral presentation in male gender and characteristic features (FFA and ICGA). This is the first case reported of unilateral PIC in a male in Indian ophthalmic literature.
1. Watzke RC, Packer AJ, Folk JC, Benson WE, Burgess D, Ober RR. Punctate inner choroidopathy Am J Ophthalmol. 1984;98:572–84
2. Jampol LM, Becker KG. White spot syndromes of the retina: A hypothesis based on the common genetic hypothesis of autoimmune/inflammatory disease Am J Ophthalmol. 2003;135:376–9
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Conflict of Interest: None declared.