Multifocal inner choroiditis.

Young, moderately myopic women presenting with typical signs of ocular histoplasmosis (OHS) but negative serology or skin tests were delimited in 1984 as a new entity of "punctate inner choroidopathy". On the basis of observations in 17 patients combined with similar cases reported in the literature, the following hypothesis is proposed herein. Myopia, young age and female sex are general high-risk factors for the development of focal choroidopathy. A hypothesis is presented to explain this accumulation. Women have a significantly higher risk of developing bacteremia before the age of 50 years than do men. The attenuated choroidal vessels in myopia might elevate the risk for infectious thrombosis in the choriocapillary layer. When combined, these risk factors could significantly lower the infectious threshold, leading to infections outside areas endemic for particularly virulent agents. The more general term multifocal inner choroiditis, proposed by Krill in 1968, should be maintained to emphasise the multifactorial genesis of this disease. Patients go to an ophthalmologist when secondary complications such as subretinal neovascular membranes have developed; this makes the search for causes of the primary infection difficult, if not impossible. Further studies carried out in collaboration with gynaecologists and other subspecialists are necessary to challenge this hypothesis and to evaluate the possibilities of preventing multifocal inner choroiditis.