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Unilateral Punctate inner choroidopathy with choroidal neovascular membrane in a young male

Biswas, Jyotirmay; Raman, Rajiv1; Bhojwani, Deepak2

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Indian Journal of Ophthalmology: September 2014 - Volume 62 - Issue 9 - p 949-950
doi: 10.4103/0301-4738.143939
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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).[1] 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.

Presentation

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].

Figure 1
Figure 1:
Color fundus photograph of left eye showing partially scarred choroidal neovascular membrane with punctate choroidal lesions

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. 57]. 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.

Figure 2
Figure 2:
Left eye montage of Fluorescein Angiography (FA) late arteriovenous (AV) phase showing punctate hyperfluorescent choroidal lesions with scarred choroidal neovascular membrane
Figure 3
Figure 3:
Fundus Flouroscein Angiography (FA): Early phase showing hyperfluorescent choroidal lesions with hypofluorescence around choroidal neovascular membrane
Figure 4
Figure 4:
Fundus Flouroscein Angiography (FA): Late phase showing extensive hyperfluorescent choroidal lesions with leak around superior area of choroidal neovascular membrane
Figure 5
Figure 5:
Indocyanine green Angiography: Early phase showing hypofluorescent lesions at choroidal levels in the posterior pole with hypofluorescence around choroidal neovascular membrane
Figure 6
Figure 6:
Indocyanine green Angiography: Middle phase showing dilated choroidal vessels around punctate choroidal lesions
Figure 7
Figure 7:
Indocyanine green Angiography: Late phase showing persisting hypofluorescence around choroidal lesions with hyperfluorescence around choroidal neovascular membrane

Discussion

PIC is a rare inflammatory choroiditis; some believe multifocal choroiditis and PIC as spectrum of a single disease.[2] 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

Source of Support: Nil.

Conflict of Interest: None declared.

Keywords:

Choroidal neovascular membrane; punctate inner choroidopathy; young adult male; unilateral PIC

© 2014 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow