PUNCTATE INNER CHOROIDOPATHY AFTER PARS PLANA VITRECTOMY FOR HIGH MYOPIC FULL-THICKNESS MACULAR HOLE

The objective of this study was to describe a case of punctate inner choroidopathy (PIC) and secondary or epiphenomenon multiple evanescent white dot syndrome after surgery for high-myopic full-thickness macular hole.

This was a case report.

A 57-year-old high-myopic woman was diagnosed with cataract and full-thickness macular hole in the left eye. Her initial best-corrected visual acuity was 20/20 in the right eye and 20/80 in the left eye. She underwent routine combined phacoemulsification and 25-gauge pars plana vitrectomy with the inverted internal limiting membrane technique and twice-repeated epiretinal membrane and internal limiting membrane staining in the left eye. Two weeks postoperatively, the patient reported significant visual decline and photopsia in her left eye. Best-corrected visual acuity decreased to counting fingers. Anterior segment examination was unremarkable. Ophthalmoscopic examination showed multiple whitish-yellow lesions in the macular region compatible with PIC lesions in the left eye. Optical coherence tomography, blue-light fundus autofluorescence, fluorescein angiography, and indocyanine green angiography were performed and confirmed the diagnosis. The patient underwent oral steroid therapy for PIC treatment. One week after treatment initiation, blue-light fundus autofluorescence showed the occurrence of epiphenomenon multiple evanescent white dot syndrome. After 1 month, all lesions resolved and best-corrected visual acuity improved to 20/100.

The authors report a rare case of PIC and epiphenomenon multiple evanescent white dot syndrome development after surgery for full-thickness macular hole. They hypothesize that several causes, including individual susceptibility (high myopia and female gender), postsurgical inflammation, and/or dye toxicity due to repeated staining, could have amplified this inflammatory chorioretinal response. Larger studies are needed to better understand the potential triggers of PIC development after surgery.