From the Guidelines
The management of punctate inner choroidopathy (PIC) primarily focuses on controlling inflammation and preventing vision loss, with corticosteroids as the first-line therapy, and intravitreal anti-VEGF agents for sight-threatening disease or cases with choroidal neovascularization (CNV). For mild cases without macular involvement, observation may be sufficient as some lesions can resolve spontaneously. When treatment is needed, corticosteroids are typically started with oral prednisone at 1 mg/kg/day with a gradual taper over 4-6 weeks. For recurrent or steroid-resistant cases, immunosuppressive agents like mycophenolate mofetil (1-3 g/day), azathioprine (1-3 mg/kg/day), or methotrexate (7.5-25 mg weekly) may be necessary, as suggested by guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis 1. Regular monitoring with OCT, fluorescein angiography, and visual field testing is essential to assess treatment response and detect complications early, with the goal of preserving vision by controlling inflammation and preventing permanent structural damage to the retina and choroid. Key considerations in managing PIC include:
- Controlling inflammation to prevent vision loss
- Using corticosteroids as the first-line therapy
- Employing intravitreal anti-VEGF agents for CNV complications
- Monitoring disease activity and adjusting therapy as needed, based on parameters such as visual acuity and ocular inflammation 1. In cases where the initial therapy is not effective, transitioning to an alternative or additional agent may be necessary, taking into account factors such as the patient’s history, underlying cause of uveitis, patient preference, cost, and convenience 1. The most recent and highest quality study on the topic of noninfectious uveitis, including PIC, emphasizes the importance of individualizing therapy choices based on multiple factors, including the patient’s history and underlying cause of uveitis 1.
From the Research
Management Approach for Punctate Inner Choroidopathy
The management approach for punctate inner choroidopathy (PIC) involves various treatment options, including:
- Immunosuppressants
- Corticoids
- Laser photocoagulation
- Photodynamic therapy
- Intravitreal anti-vascular endothelial growth factor (VEGF) agents
- Submacular surgery 2
Treatment of Choroidal Neovascularization (CNV) Associated with PIC
For CNV associated with PIC, the treatment approach may include:
- Combination of intravitreal anti-VEGF and systemic immunosuppressive therapy 3
- Intravitreal ranibizumab monotherapy or combined oral corticosteroid and intravitreal ranibizumab therapy 4
- Systemic corticosteroids and intravitreal anti-VEGF injection 5
Comparison of Treatment Outcomes
Studies have compared the treatment outcomes of different approaches, including:
- Ranibizumab monotherapy vs combined corticosteroid-ranibizumab therapy, with the latter showing better resolution of PIC lesions and fewer new PIC lesions 4
- Anti-VEGF treatment for CNV secondary to PIC vs myopia, with the former requiring more intravitreal injections and having a higher number of relapses 6
Key Considerations
Key considerations in the management of PIC include:
- Early identification and treatment to preserve visual function and prevent severe complications like CNVM 5
- Long-term follow-up to monitor disease progression and adjust treatment as needed 5
- Individualized treatment approach based on the specific characteristics of the patient and the disease 3, 4, 6