State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Ophthalmology. 2013 Dec;120(12):2678-2683. doi: 10.1016/j.ophtha.2013.05.012. Epub 2013 Jun 12.
To describe the natural course of punctate inner choroidopathy (PIC) using spectral-domain optical coherence tomography (SD-OCT).
Prospective observational case series.
Forty-two consecutive patients (60 eyes) with PIC with at least 3 months of follow-up.
Serial SD-OCT images were obtained from both eyes of each participant at each visit.
The morphologic characteristics of each stage of PIC lesions observed by SD-OCT.
Continued stage progression of PIC lesions was observed in 27 eyes (45%), among which choroidal thickness changes were observed in 8 eyes (30%). Stage I lesion showed a normal appearance or slight irregularities in the outer nuclear layer. Stage II lesion appeared as a focal elevation of the retinal pigment epithelium (RPE) with corresponding disruption of the inner and outer segments of the photoreceptor interface. Stage III lesion broke through the RPE, forming a hump-shaped chorioretinal nodule with moderate reflectivity beneath the outer plexiform layer (OPL), generally with subsequent disruption of Bruch's membrane. Nodules occasionally invaded the inner retina, causing segmental retinal phlebitis in 2 eyes. Stage IV lesion regressed in a retrograde manner with tissue loss from the photoreceptor layer and inner choroid, finally leaving a V-shaped hernia of the OPL and inner retina into the choroid. Stage V lesion gradually eliminated the photoreceptors around the lesion; this process was accompanied by RPE proliferation at multiple levels, which reduced retinal herniation. Parafoveal stage V lesions caused late occult macular atrophy in 4 eyes. Choroidal thickness increased throughout the active phase and reached a peak at stage III; this parameter then significantly decreased at stage IV and gradually reached a minimum that was lower than the initial value at stage I.
Punctate inner choroidopathy is a chorioretinitis rather than an inner choroidopathy. Spectral-domain OCT characterized a 5-stage evolution of PIC lesions: choroidal infiltration, formation of sub-RPE nodules, and then chorioretinal nodules, regression, and retinal herniation.
利用频域光相干断层扫描（SD-OCT）描述点状内层脉络膜病变（PIC）的自然病程。
前瞻性观察性病例系列。
42 例（60 只眼）PIC 患者，至少随访 3 个月。
对每个患者的双眼在每次就诊时均进行 SD-OCT 图像序列采集。
SD-OCT 观察到的 PIC 病变各期的形态特征。
27 只眼（45%）观察到 PIC 病变持续进展，其中 8 只眼（30%）出现脉络膜厚度变化。Ⅰ期病变表现为外核层外观正常或轻微不规则。Ⅱ期病变表现为视网膜色素上皮（RPE）局灶性隆起，伴有光感受器内外节连接中断。Ⅲ期病变突破 RPE，在外丛状层（OPL）下形成一个具有中等反射性的丘状脉络膜结节，一般伴有随后的 Bruch 膜破裂。结节偶尔侵入内视网膜，导致 2 只眼出现节段性视网膜静脉炎。Ⅳ期病变逆行消退，光感受器层和内层脉络膜组织丢失，最终 OPL 和内视网膜形成 V 形疝入脉络膜。Ⅴ期病变逐渐消除病变周围的光感受器；在此过程中，RPE 在多个层次增生，减少视网膜疝出。旁中心区Ⅴ期病变导致 4 只眼出现晚期隐匿性黄斑萎缩。活跃期脉络膜厚度逐渐增加，于Ⅲ期达到峰值；此参数在Ⅳ期明显下降，逐渐达到Ⅰ期的最低值。
点状内层脉络膜病变是一种脉络膜视网膜炎，而不是内层脉络膜病变。频域 OCT 对 PIC 病变的 5 期演变进行了特征描述：脉络膜浸润、形成 RPE 下结节，然后是脉络膜视网膜结节、消退和视网膜疝出。
