Vitreous Retina Macula Consultants of New York, 460 Park Avenue, New York, NY 10022, USA.
Retina. 2013 Jul-Aug;33(7):1315-24. doi: 10.1097/IAE.0b013e318286cc77.
To evaluate the characteristics of multifocal choroiditis and panuveitis (MCP) and punctate inner choroidopathy (PIC) using multimodal imaging.
This is a retrospective, consecutive, observational case series of 38 eyes of 22 patients. Each eye of patients with multiple yellow-white idiopathic inflammatory lesions in the fundus was classified as having MCP or PIC using standard diagnostic criteria in a masked fashion. The features of these eyes as determined from color fundus photography, spectral-domain optical coherence tomography, fundus autofluorescence, and angiography were compared across diagnostic categories. The main outcome measures were the features of both MCP and PIC as evidenced by multimodal imaging.
Of the 38 eyes, 23 eyes had MCP, 15 had PIC; and 7 patients had a discordant pairing of one diagnosis in 1 eye with the other diagnosis in the fellow eye. Acute lesions appeared as nodular collections under the retinal pigment epithelium. These solid retinal pigment epithelium detachments appeared to rupture leading to inflammatory infiltration of the subretinal space and outer retina, often with a widespread loss of the outer retinal architecture beyond the confines of the inflammatory exudate. Treatment with corticosteroids caused a rapid regression of this material with a slower resolution of the abnormalities of the outer retinal architecture. The pattern of inflammatory involvement seen by multimodal imaging did not vary between PIC and MCP. No consistent abnormalities were seen in the choroid in either condition, although there was slight thickening of the choroid underlying some acute lesions.
Despite the names of these diseases, the principle sites involved appears to be the subretinal pigment epithelium and outer retinal spaces. Because both MCP and PIC target the same essential structures in the same phenotypic manner and, when active, are treated the same way, there seems to be limited clinical utility in trying to differentiate them. Based on multimodal imaging results, a reappraisal of pathogenic features and naming conventions of these diseases seems indicated.
利用多模态成像评估多灶性脉络膜炎和全葡萄膜炎(MCP)及点状内层脉络膜病变(PIC)的特征。
这是一项回顾性、连续、观察性病例系列研究,共纳入 22 名患者的 38 只眼。对眼底存在多个黄色白色特发性炎症性病变的每只眼,采用标准诊断标准进行盲法分类,判断其为 MCP 或 PIC。比较这些眼在彩色眼底照相、频域光学相干断层扫描、眼底自发荧光和血管造影方面的特征。主要观察指标为多模态成像确定的 MCP 和 PIC 的特征。
38 只眼中,23 只眼为 MCP,15 只眼为 PIC;7 名患者一眼诊断为 MCP,对侧眼诊断为 PIC,双眼诊断不一致。急性病变表现为视网膜色素上皮下结节样积聚。这些实性视网膜色素上皮脱离似乎破裂,导致视网膜下间隙和外视网膜炎症浸润,常伴有外视网膜结构广泛缺失,超出炎症渗出物的范围。皮质类固醇治疗可迅速消退该物质,但外视网膜结构异常的消退速度较慢。PIC 和 MCP 两种疾病的多模态成像所见炎症受累模式无差异。两种疾病的脉络膜均未见一致的异常,尽管在一些急性病变下方的脉络膜轻度增厚。
尽管这些疾病有特定的名称,但主要受累部位似乎是视网膜下色素上皮和外视网膜间隙。鉴于 MCP 和 PIC 以相同的表型方式靶向相同的基本结构,且在活动期的治疗方法相同,因此试图对其进行区分似乎没有多少临床意义。基于多模态成像结果,这些疾病的发病特征和命名规范似乎需要重新评估。