Punctate Inner Choroidopathy

A patient presented to the Bascom Palmer emergency room complaining of seeing a fixed gray spot out of the right eye for two weeks. Past history was unremarkable. Vision was 20/70 OD and 20/30 OS. Intraocular pressure and pupils were normal. The anterior exam was normal for both eyes. The fundus exam for the right eye was notable for a round circumscribed hyperpigmented lesion abutting the fovea and numerous punctate yellow-grey spots limited to the posterior pole. The fundus exam of the left eye was normal. Fundus autofluorescence of the right eye revealed numerous hyper-autofluorescent dots throughout the posterior pole corresponding to the lesions seen on fundus exam. On fluorescein angiogram, these lesions were hyperfluorescent with late staining. On ICG, the perifoveal lesion was well-circumscribed and hypocyanescent throughout the early, middle, and late phases. OCT demonstrated focal areas of IS/OS disruption and a large subretinal lesion without associated fluid. The patient was diagnosed with punctate inner choroidopathy with choroidal neovascularization. At follow-up two weeks later, vision was 20/30 in the right eye, and on imaging the lesions appeared to be regressing with the CNVM remaining inactive. The patient was offered the choice of observation versus treatment with steroids, and the patient chose to observe, given that their vision was better, and their disease appeared to be resolving on its own. The patient was given close follow up, and their condition progressively improved. At their most recent visit, vision was 20/20 in both eyes, the lesions appeared to be completely resolved, and the CNVM lesion remained stable and inactive.

Presentation Date: 07/13/2023

Issue Date: 07/28/2023