DIFFERENTIAL RESPONSE TO GLUCOCORTICOID IMMUNOSUPPRESSION OF TWO DISTINCT INFLAMMATORY SIGNS ASSOCIATED WITH PUNCTATE INNER CHOROIDOPATHY. Issue 4 (April 2021)

• Record Type: Journal Article
• Authors: Abdelhakim, Aliaa H.; Yannuzzi, Lawrence A.; Freund, K. Bailey; Jung, Jesse J.
• Is Part Of: Retina. Volume 41:Issue 4(2021)
• Publication Date: 2021-04
• Subjects: focal choroidal excavation -- fundus autofluorescence -- glucocorticosteroids -- multimodal imaging -- optical coherence tomography -- outer retinal photoreceptor disruption -- punctate inner choroidopathy -- acute retinal pigment epithelium/Bruch membrane lesion; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000002950
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: To describe the differential response of two distinct inflammatory signs occurring in eyes with punctate inner choroidopathy. Methods: Retrospective, observational case series using multimodal imaging. Results: Four eyes of 4 myopic female patients (mean age of 35 years, range 31–42 years) presenting with retinal manifestations of punctate inner choroidopathy. All study eyes had 2 distinct signs of active disease: 1) acute focal hyperreflective lesions splitting the retinal pigment epithelium/Bruch membrane complex on optical coherence tomography which appeared hypoautofluorescent on fundus autofluorescence and 2) more diffuse areas of outer retinal disruption limited to the ellipsoid zone and interdigitation zone on optical coherence tomography and corresponding to hyperautofluorescence on fundus autofluorescence. All patients were treated with oral prednisone and demonstrated prompt regression of the retinal pigment epithelium/Bruch membrane complex lesions with a concurrent, paradoxical centrifugal expansion of outer retinal disruption. The outer retinal disruption eventually resolved in all eyes (mean time of 6 weeks, range 4–10 weeks). Conclusion: In patients with punctate inner choroidopathy, two distinct inflammatory signs observed with multimodal imaging display a differential response to systemic corticosteroids. Although focal inflammatory lesions splitting the retinal pigment epithelium/Bruch membrane complex seem to respond rapidly, the more diffuse, transient outer retinal disruption shows little response. This difference in treatment response may reflect different immunological phenomena with independent natural history. Abstract : Multimodal imaging shows that different types of inflammatory lesions in punctate inner choroidopathy seem to respond differently after the initiation of treatment with systemic glucocorticoid immunosuppression. The focal subretinal pigment epithelium lesions seem to respond promptly, while initially, the more diffuse outer retinal photoreceptor disruption may progress.