Hohberger Bettina, Rudolph Michael, Bergua Antonio
Department of Ophthalmology and Eye Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Case Rep Ophthalmol. 2015 Nov 27;6(3):385-9. doi: 10.1159/000441694. eCollection 2015 Sep-Dec.
Choroidal neovascularization (CNV) associated with punctate inner choroidopathy (PIC) is a rare clinical entity, yet still a challenge for medical treatment. A case of a young myopic woman developing CNV secondary to unilateral PIC is presented. Clinical morphology, diagnostic procedure and follow-up are reported.
A 29-year-old woman presented with multiple yellowish dots at the posterior pole. No other signs of inflammation could be seen. Angiography with fluorescein yielded hyperfluorescent signals in the affected areas with a diffuse leak, and SD-OCT showed a slightly elevated retinal pigment epithelial layer, consistent with the diagnosis of PIC. Additionally a classic CNV was observed.
Anti-inflammatory therapy with local prednisolone acetate eye drops in combination with intravitreal injection of anti-vascular endothelial growth factor (VEGF, bevacizumab) yielded an increased best-corrected visual acuity. As CNV reappeared, systemic medication with prednisone and azathioprine in combination with two further intravitreal injections of anti-VEGF stabilized CNV and increased visual acuity again.
Combined therapy of immunosuppression with intravitreal anti-VEGF injections can be considered as therapeutic strategy in the management of recurrent CNV associated with PIC.
与点状内层脉络膜病变（PIC）相关的脉络膜新生血管（CNV）是一种罕见的临床病症，然而在医学治疗上仍是一项挑战。本文报告了一例年轻近视女性继发于单侧PIC而发生CNV的病例。报告了其临床形态、诊断过程及随访情况。
一名29岁女性患者后极部出现多个淡黄色斑点。未见其他炎症迹象。荧光素血管造影显示病变区域有高荧光信号且有弥漫性渗漏，频域光学相干断层扫描（SD-OCT）显示视网膜色素上皮层轻度隆起，符合PIC的诊断。此外还观察到典型的CNV。
局部使用醋酸泼尼松龙滴眼液联合玻璃体内注射抗血管内皮生长因子（VEGF，贝伐单抗）进行抗炎治疗，使最佳矫正视力提高。由于CNV复发，使用泼尼松和硫唑嘌呤全身用药并再次进行两次玻璃体内抗VEGF注射，使CNV稳定且视力再次提高。
免疫抑制与玻璃体内抗VEGF注射联合治疗可被视为治疗与PIC相关的复发性CNV的治疗策略。
