Incidence of bilateral disease and choroidal neovascularisation in punctate inner choroiditis

To characterise the incidence of bilateral involvement and choroidal neovascularisation (CNV) in punctate inner choroiditis (PIC).

Retrospective, single-centre case series of 52 patients with PIC evaluated at a tertiary referral centre in the USA. Patients meeting Standardization of Uveitis Nomenclature criteria were included. Records were reviewed for laterality, CNV, treatment and visual outcomes. Incidence rates were calculated using person-year and eye-year denominators with staggered entry anchored at PIC diagnosis. Kaplan-Meier methods were used for time-to-event analyses. Time-updated analysis assessed immunosuppression as a risk modifier for active CNV.

At diagnosis, 31/52 patients (59.6%) had unilateral disease. During follow-up, 11 developed fellow-eye involvement (0.08/person-year; 95% CI 0.04 to 0.13), with the highest incidence within 5 years of diagnosis (0.20/person-year; 95% CI 0.09 to 0.36). None of the four unilateral patients treated with immunosuppression developed fellow-eye disease while receiving therapy. At diagnosis, CNV was present in 34/73 eyes (46.6%). During follow-up, 20 eyes developed incident CNV (0.06/eye-year; 95% CI 0.04 to 0.10), highest within 5 years of diagnosis (0.14/eye-year; 95% CI 0.08 to 0.22). In time-updated analysis controlling for prior CNV, immunosuppression was associated with reduced odds of active CNV (OR, 0.50; 95% CI 0.27 to 0.93). 10 eyes developed visual acuity worse than 20/40, all associated with CNV; 8 improved to better than 20/40 after anti-vascular endothelial growth factor therapy.

PIC frequently presents unilaterally but carries risk of bilateral progression. CNV is common at presentation and is a cause of vision loss. Immunosuppression is associated with reduced odds of active CNV.