Punctate Inner Choroidopathy Ahmed Magdy Bedda, MD, PhD Professor of Ophthalmology Rowayda M. Amin, MSc Assistant lecturer of Ophthalmology Alexandria University

Ocular History 25 year old female presented with recent diminution of vision in her OD 25 year old female presented with recent diminution of vision in her OD gradual progressive loss of vision in her OS over the previous 1.5 years gradual progressive loss of vision in her OS over the previous 1.5 years no steroid or immunomodulatory therapy no steroid or immunomodulatory therapy

First presentation OD: OD: BCVA 6/12 BCVA 6/12 anterior segment was anterior segment wasunremarkable trace vitreous cell trace vitreous cell Fundus: Fundus: small, white-yellow lesions at the level of the choroid and RPE that surround the disc and the macular region small, white-yellow lesions at the level of the choroid and RPE that surround the disc and the macular region

First Presentation OS: OS: BCVA 1/60 BCVA 1/60 Anterior segment Anterior segmentunremarkable no vitreous cell no vitreous cell Fundus: Fundus: multiple small, white-yellow punched out lesions that surround the disc with older pigmented lesions involving the macula multiple small, white-yellow punched out lesions that surround the disc with older pigmented lesions involving the macula

Investigations FA: Early hyperfluorescence with late staining and leakage of the macular lesions FA: Early hyperfluorescence with late staining and leakage of the macular lesions

Investigations

Treatment oral prednisone oral prednisone 60 mg daily for two weeks 60 mg daily for two weeks followed by weekly 10 mg taper down to 20 mg followed by weekly 10 mg taper down to 20 mg then 5 mg biweekly taper over another 4 weeks then 5 mg biweekly taper over another 4 weeks Azathioprine 50mg bid Azathioprine 50mg bid

6 Weeks after Treatment OD: OD: BCVA 6/9 BCVA 6/9 Fundus lesions have Fundus lesions have scarred and are more well-defined with a discrete border.

6 Weeks after Treatment OS: OS: BCVA: 6/9 BCVA: 6/9 Fundus lesions have Fundus lesions have more well-defined edges and a punched-out appearance with some more pigmentation.

Conclusion PIC is an idiopathic disorder within the spectrum of multifocal choroiditides PIC is an idiopathic disorder within the spectrum of multifocal choroiditides typically it is not associated with intraocular inflammation typically it is not associated with intraocular inflammation prognosis is good unless complicated with submacular lesions or choroidal neovascular membranes prognosis is good unless complicated with submacular lesions or choroidal neovascular membranes