To describe longitudinal anatomic and functional alterations due to inflammatory and neovascular lesions of idiopathic multifocal choroiditis/punctate inner choroidopathy using adaptive optics imaging and microperimetry.
Longitudinal case study using multiple imaging modalities including spectral domain optical coherence tomography (OCT), fluorescein angiography, indocyanine green angiography, OCT angiography, flood illumination adaptive optics (FIAO), and microperimetry (“Macular integrity assessment,” MAIA).
A 21-year-old myopic Asian male presented with blurred vision in the right eye. Clinical examination was notable for an isolated hypopigmented, perifoveal lesion in each eye. Multimodal imaging showed inflammatory lesions in the outer retina, retina pigment epithelium, and inner choroid lesions of both eyes. The right eye additionally exhibited active type 2 macular neovascularization with loss of cone mosaic regularity that was associated with reduced sensitivity on microperimetry. The clinical picture was consistent with multifocal choroiditis/punctate inner choroidopathy. The patient was treated with oral steroids and three injections of intravitreal bevacizumab in the right eye. After therapy, imaging showed re-establishment of the cone mosaic on FIAO and improvement in sensitivity on microperimetry.
Adaptive optics imaging and microperimetry may detect biomarkers that help to characterize the nature and activity of multifocal choroiditis lesions and to help monitor response to therapy. With timely intervention, structural abnormalities in the outer retina and choroid can be treated and anatomical improvements precede improvements in visual function.