Idiopathic Multifocal Choroiditis and Punctate Inner Choroidopathy – Evaluation of Risk Factors for Increased Relapse Rate: A 2-Year Prospective Observational Cohort Study

Abstract

Introduction: The aim of this study was to describe the course of disease in patients with idiopathic multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) and to identify risk factors associated with an increased relapse rate of disease activity. Methods: In this prospective observational cohort study, demographical and clinical data were collected concerning the relapses rate of disease activity, the conclusions of the multimodal imaging results, treatment, complications, and self-reported quality of life. Disease activity was defined as new inflammatory lesions or active inflammation in preexisting chorioretinal lesions either with or without active choroidal neovascularization (CNV). Linear regression analysis was performed to identify risk factors associated with an increased relapse rate. Results: In total, 122 eyes of 82 patients (93% females) were included with a median age (IQR) of 45 (37–54) years. A history of secondary CNV was present in 66% of the eyes. During follow-up, the best-corrected visual acuity remained stable despite a median relapse rate (IQR) of 1.0 (0.25–3). Cycles of oral corticosteroids were given in 59% of the patients, 72% were treated at baseline or started treatment during follow-up with a disease-modifying antirheumatic drug (DMARD), and 35% with a biological agent in addition to the DMARD. Both a history of secondary CNV (B = 1.2, 95% CI: 0.7–1.7, p = 3.6 × 10−5) and high myopia (<−6 diopters) (B = 0.6, 95% CI: 0.1–1.1, p = 0.02) independently increased the relapse rate of disease activity. Discussion/Conclusion: A history of secondary CNV and high myopia were associated with an increased relapse rate of disease activity. Moreover, the results of this study emphasize the challenging character of treating patients with MFC/PIC.