Punctate inner choroiditis

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Discard choroiditis in (PIC) is an inflammatory chloroiditis that occurs primarily in young women. Symptoms include blurred vision and scotomata. Yellow lesions are mainly in the posterior pole and are between 100 and 300 micrometers in size. PIC is one called White Dot Syndrome. PIC has only been recognized as a recent distinct condition as 1984 when Watzke identified 10 emerging patients to form different groups in the White Dot Syndrome.

Video Punctate inner choroiditis

Clinical presentation

o Usually affects farsightedness (nearsightedness). (90% of cases are women).

o The mean age of patients with PIC is 27 years with a range of 16-40 years.

o Patients are declared healthy and usually there is no disease, which triggers the condition or precedes it.

o Inflammation is limited to the back of the eye (posterior). There is no inflammation in front of the eyes (anterior chamber) or vitreous (clear jelly inside the eye). This is an important distinguishing feature of the PIC.

Usually affects both eyes.

o The appearance of white or yellow striped areas (puncture out) (lesions) at the level of the inner choroid. These lesions are usually located in the center behind the eyes (posterior pole).

Symptoms usually include:

1. Blurring of vision
2. Partly a "blind spot" or a scotoma. Missing or missing areas of the visual field are usually located near the center of vision but can sometimes be peripheral. This may be temporary or permanent.
3. See the blinking lights. This is known as photopsia.

PIC lesions, which form deep scars within the coroid lining of the eye, can lead to the formation of new blood vessels. This can be seen as an attempt to repair the body, but new blood vessels (neovascularization) are weak, can spread to form membranes and can threaten vision. It is suspected that at least 40% of patients with PIC develop CNV (choroid neovascularization). This is a complication, which can occur in other white spot syndromes and other eye conditions such as macular degeneration but rarely occurs in other forms of uveitis.

CNV is a threatening complication of vision and must be picked up early and always treated. This can happen whether uveitis is active or not. CNV, if left untreated, can lead to subretinal fibrosis (scar tissue), further complications, which are more difficult to treat, and which lead to poor vision.

Good monitoring for patients with PIC is therefore very important.

Maps Punctate inner choroiditis

Cause

There is no known cause of the PIC, but may be a type of autoimmune uveitis.

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Diagnosis

The diagnosis of PIC can be difficult because appearance may be similar to other conditions and types of posterior uveitis, especially other forms called white spot syndrome. Diagnosis is made by eliminating all other possibilities with careful examination by experienced eye doctors, assisted by visual field tests and fluorescence angiography (intra-veneous dyes used to show blood vessels in the back of the eye).

It is important that a correct diagnosis be made because the treatment may be very different for seemingly similar conditions.

The natural state of the condition

What happens to the PIC depends heavily on the presence or absence of important complications, Choroidal neovascularization (known as CNV).

Often, inflammation of the PICs limits itself, does not necessarily require treatment.

However, treatment is recommended if there are many active or central lesions, or if there are CNV signs.

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Treatment

It is important to distinguish between the underlying inflammatory treatment (PIC) and CNV treatment.

2-way approach:

Treatment is not always necessary and observation may be appropriate for lesions if found in unseen areas (which are not centered).

PIC active lesions may be treated with systemic (tablet) or systemic corticosteroids with injections around the eyes (periorbital). It has been argued that treating lesions in this way can help minimize CNV development.

CNV Treatment:

Early care is required for these complications. There are several possible treatment methods, but no treatment seems to be effective for CNV treatment.

1. Corticosteroids: systemic or intraocular
2. Secondary immunouppressants: There is evidence that second-line steroid and immunosuppressant combination therapy may be important.
3. Surgical excision of the affected area in well-chosen cases.
4. Intravitreal anti-VEGF agent. Examples are bevacizumab (avastin) and ranibizumab. These relatively new drugs are injected into the eye.
5. Photodynamic therapy (PDT): Photosensitive drugs are 'activated' by strong light. Consideration may be given to PDT and anti VEGF combined therapy.
6. Laser photocoagulation: This is sometimes used unless CNV is subfoveal (affects the central or visual macula). Laser treatment can damage vision.

Use of the intravitreal anti-VEGF agent bevacizumab and ranibizumab has been described recently. The current evidence supports the use of anti-VEGF agents based on retrospective case studies and can not be described as strong. However, further data from prospective controlled trials is required before the therapeutic role of anti-VEGF therapy in a uveitis treatment regimen can be fully determined. Further anti-VEGF agents have not been shown to have anti-inflammatory effects.

Thus, treatment of underlying inflammatory diseases should play a central role in the management of uveitic CNV. The two-pronged treatment focuses on achieving inflammatory control through the use of corticosteroids and/or immunosuppressive agents, while treating complications arising despite adequate disease control with intravitreal anti-VEGF agents, may be useful.

Regular monitoring is very important to achieve good results. This is because even if there is no active inflammation, there may still be occult CNVs that require treatment to avoid losing vision suffering.

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Prognosis

The visual prognosis of the eye with a PIC that does not develop CNV subfoval is good. If CNV is taken early and treated appropriately then the visual results can also be good. Frequent monitoring is important to ensure good results. Poor vision occurs mostly with subfoveal CNV or if subretinal fibrosis (scar tissue) has formed.

The above information is derived from a fact sheet produced by the Uveitis Information Group in May 2011. It has been factually reviewed by members of the Professional Medical Panel charity.

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References

Source of the article : Wikipedia