Redefining multifocal choroiditis and panuveitis and punctate inner choroidopathy through multimodal imaging

Area of Science:

• Ophthalmology
• Medical Imaging
• Inflammatory Eye Diseases

Background:

• Multifocal choroiditis and panuveitis (MCP) and punctate inner choroidopathy (PIC) are inflammatory conditions affecting the inner choroid and retina.
• Accurate differentiation between MCP and PIC is crucial for appropriate patient management and understanding disease pathogenesis.
• Multimodal imaging offers a comprehensive approach to visualize ocular structures and inflammatory processes.

Purpose of the Study:

• To characterize and compare the multimodal imaging features of multifocal choroiditis and panuveitis (MCP) and punctate inner choroidopathy (PIC).
• To evaluate the clinical utility of differentiating between MCP and PIC based on imaging findings.

Main Methods:

• Retrospective, observational case series of 38 eyes from 22 patients diagnosed with MCP or PIC.
• Standard diagnostic criteria were used for masked classification of eyes into MCP or PIC groups.
• Multimodal imaging techniques including color fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, and angiography were employed.

Main Results:

• Acute lesions in both MCP and PIC presented as nodular subretinal pigment epithelium collections that could rupture, leading to inflammatory infiltration and outer retinal damage.
• Multimodal imaging revealed no significant differences in the pattern of inflammatory involvement between MCP and PIC.
• Corticosteroid treatment showed rapid regression of inflammatory material but slower resolution of outer retinal architectural abnormalities.

Conclusions:

• The primary affected sites in both MCP and PIC are the subretinal pigment epithelium and outer retinal spaces.
• Given the similar phenotypic presentation and treatment response, the clinical distinction between MCP and PIC appears limited.
• Reappraisal of the pathogenic features and nomenclature of MCP and PIC is warranted based on these multimodal imaging findings.