Abstract
Purpose. To investigate the fundus autofluorescence (FAF) spectrum of punctate inner choroidopathy (PIC). Methods. This is a retrospective observational case series of 27 consecutive patients with PIC admitted from October 2013 to March 2015, who underwent short-wavelength- (SW-) and near-infrared- (NIR-) FAF imaging, spectral domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA). Results. There were three primary findings on the FAF imaging of patients with PIC. First, active PIC lesions revealed hypoautofluorescent spots with hyperautofluorescent margin. After the lesions regressed, the hyperautoflurescent margin faded. Second, subclinical and most of the atrophic PIC lesions appeared to be hypoautofluorescent spots. But subclinical PIC lesions were more distinctive on NIR-FAF imaging than on SW-FAF imaging. Third, hypoautofluorescent spots of PIC lesions coexisted with hyperautofluorescent patches on SW-FAF imaging. These hyperautofluorescent patches were demonstrated to be multiple evanescent white dot syndrome (MEWDS) or acute zonal occult outer retinopathy (AZOOR) lesions by subsequent multimodal imaging and faded during follow-up examinations. Conclusion. FAF imaging helps in noninvasively tracking the evolution of PIC lesions and identifying the combined MEWDS or AZOOR lesions, complementary to SD-OCT and angiographic studies.
Highlights
Punctate inner choroidopathy (PIC), a disease that typically affects young myopic women, is characterized by multiple, small, and yellow-white spots mainly in the posterior pole without signs of anterior uveitis or vitritis
The hyperautofluorescent margin was more profound when it was imaged by SW-FAF
While some atrophic lesions could harbor the hyperautofluorescent margin, they cannot be differential from active lesions by FAF imaging independently
Summary
Punctate inner choroidopathy (PIC), a disease that typically affects young myopic women, is characterized by multiple, small, and yellow-white spots mainly in the posterior pole without signs of anterior uveitis or vitritis. The lesions resolve with time, leaving atrophic spots with variable pigmentation [1]. The PIC lesions are thought to occur at the level of the inner choroid and retinal pigment epithelium (RPE) [1]. Fundus autofluorescence (FAF) imaging includes shortwavelength- (SW-) and near-infrared- (NIR-) FAF imaging; they visualize naturally occurring fluorophores of lipofuscin from RPE and melanin from choroid, respectively [2,3,4]. We aimed to analyze the varied FAF manifestations of PIC according to its phases with 27 patients Use of FAF imaging in the diagnosis and followup examinations of PIC may help in understanding of the pathophysiology, as well as the interpretation of angiographic and spectral domain optical coherence tomography (SDOCT) patterns.
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