Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom.
Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom; Technion, Israel Institute of Technology, Haifa, Israel.
Ophthalmology. 2018 Feb;125(2):288-294. doi: 10.1016/j.ophtha.2017.09.002. Epub 2017 Oct 6.
To examine a large cohort of subjects with punctate inner choroidopathy (PIC) looking at risk factors for development of choroidal neovascular membrane (CNVM) and visual loss.
Retrospective case series.
A total of 203 participants (318 eyes) with PIC seen at Moorfields Eye Hospital between 1996 and 2016.
Information was gathered from the clinical notes of all subjects identified with PIC.
Development of CNVM, moderate visual loss (MVL) (≤20/50), and severe visual loss (SVL) (≤20/200).
Participants were predominantly young (median age at presentation, 32.9 years; interquartile range [IQR], 26.1-42.2), myopic (91.5%), female (87.2%), and white (75.9%). Disease was bilateral at presentation in 115 participants (56.7%), and CNVM was present at presentation in 152 eyes (47.8%). Median follow-up was 8.4 years. New CNVM occurred in 58 eyes (33.5% of affected eyes and 4.3% of initially unaffected eyes). An increased risk of developing CNVM was associated with the presence of a CNVM in the fellow eye (P < 0.0005; hazard ratio [HR], 2.73), and previous oral corticosteroid treatment was associated with halving of the risk of developing CNVM (P = 0.035; HR, 0.45). No difference was observed in visual outcome with oral corticosteroids, but subjects treated with anti-VEGF had better visual outcomes (12-month median visual acuity, logarithm of the minimum angle of resolution [logMAR] 0.00 with anti-VEGF and 0.20 without; P = 0.018). Median best-corrected visual acuity (BCVA) was 20/30 at presentation (IQR, 0.00-0.50) and remained at 20/30 throughout all follow-up periods. Moderate visual loss occurred in 40 eyes (12.6%), with an incidence of 0.01 per eye-year, and SVL occurred in 49 eyes (15.4%), with an incidence of 0.01 per eye-year. Female participants were half as likely as male participants to develop MVL (P = 0.030; HR, 0.448), and participants with CNVM had a higher risk of MVL (P = 0.003; HR, 21.074).
Visual loss is common in subjects with PIC, predominantly secondary to late development of CNVM. Treatment with oral corticosteroids may help to reduce the risk of CNVM development, and anti-VEGF therapy for CNVM was associated with better clinical outcomes.
观察大量点状内层脉络膜病变（PIC）患者，探讨脉络膜新生血管膜（CNVM）和视力丧失的发展风险因素。
回顾性病例系列。
203 名（318 只眼）于 1996 年至 2016 年在 Moorfields 眼科医院就诊的 PIC 患者。
从所有确诊为 PIC 的患者的临床记录中收集信息。
CNVM、中度视力丧失（MVL）（≤20/50）和重度视力丧失（SVL）（≤20/200）的发展情况。
参与者主要为年轻患者（中位发病年龄 32.9 岁；四分位距[IQR]，26.1-42.2），近视（91.5%）、女性（87.2%）和白人（75.9%）。115 名参与者（56.7%）的疾病为双侧发病，152 只眼（47.8%）存在 CNVM。中位随访时间为 8.4 年。58 只眼（受影响眼的 33.5%和最初未受影响眼的 4.3%）发生新的 CNVM。与对侧眼存在 CNVM（P < 0.0005；风险比[HR]，2.73）相比，发生 CNVM 的风险增加，而先前的口服皮质类固醇治疗与发生 CNVM 的风险减半相关（P = 0.035；HR，0.45）。口服皮质类固醇治疗对视功能无明显影响，但接受抗血管内皮生长因子（VEGF）治疗的患者视力预后更好（12 个月时的中位视力为对数最小角度分辨率[logMAR]0.00 用抗 VEGF 和 0.20 不用；P = 0.018）。发病时最佳矫正视力（BCVA）为 20/30（IQR，0.00-0.50），整个随访期间均保持在 20/30。40 只眼（12.6%）发生中度视力丧失，发病率为 0.01/眼年，49 只眼（15.4%）发生严重视力丧失，发病率为 0.01/眼年。女性参与者发生 MVL 的可能性是男性参与者的一半（P = 0.030；HR，0.448），而有 CNVM 的参与者发生 MVL 的风险更高（P = 0.003；HR，21.074）。
PIC 患者视力下降较为常见，主要继发于晚期 CNVM 的发生。口服皮质类固醇治疗可能有助于降低 CNVM 发生的风险，抗 VEGF 治疗 CNVM 与更好的临床结局相关。
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