Systemic Immunosuppression and Secondary Choroidal Neovascularisation in Patients with Punctate Inner Chorioretinopathy
Issued Date
2025-01-01
Resource Type
ISSN
09273948
eISSN
17445078
Scopus ID
2-s2.0-105012151707
Journal Title
Ocular Immunology and Inflammation
Rights Holder(s)
SCOPUS
Bibliographic Citation
Ocular Immunology and Inflammation (2025)
Suggested Citation
Dhirachaikulpanich D., Lloyd A., Amer M., Jones W., Usman M., Babiker S., Beare N.A.V., Stylianides A. Systemic Immunosuppression and Secondary Choroidal Neovascularisation in Patients with Punctate Inner Chorioretinopathy. Ocular Immunology and Inflammation (2025). doi:10.1080/09273948.2025.2534080 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/111556
Title
Systemic Immunosuppression and Secondary Choroidal Neovascularisation in Patients with Punctate Inner Chorioretinopathy
Corresponding Author(s)
Other Contributor(s)
Abstract
Purpose: Punctate Inner Choroidopathy (PIC), a posterior uveitis primarily affecting females with myopia, was studied to evaluate CNV-free survival, CNV recurrence-free survival, and visual outcomes under different immunomodulatory treatment strategies. Methods: This two-centre retrospective study included PIC patients treated at St Pauls Eye Unit, Liverpool or Manchester Royal Eye Hospital from 2009 to 2024 with at least 1 year follow-up. Recurrent CNV was defined as CNV reappearing after a quiescent period of at least 3 months without treatment. Results: Sixty-nine patients with PIC (96 eyes) were included: 47 eyes received no systemic therapy, 40 were treated with systemic corticosteroids, and 9 with corticosteroids plus immunosuppressants (combination therapy). Incident CNV was more frequent with corticosteroids (22.5%) and combination therapy (37.5%) than without systemic therapy (12.8%), though Kaplan-Meier analysis revealed these differences were not significant. Similarly, Kaplan-Meier analysis showed no statistically significant differences in survival free of CNV recurrence across treatments, though recurrence was higher in the combination therapy group (median recurrence free survival: 30 months). Cox regression analysis identified pre-existing subfoveal fibrosis/atrophy at baseline as a significant CNV risk factor, with an increased hazard ratio (HR: 2.89, 95% CI: 1.70–4.93, p < 0.001). Subfoveal fibrosis/atrophy and younger age were linked to worse visual outcomes in univariable analysis (p < 0.05), but not after adjustment. Conclusion: This non-randomised study found no evidence that systemic immunosuppression reduces CNV occurrence, recurrence or improves PIC outcomes. Early anti-VEGF treatment is recommended for patients identified with CNV. Larger prospective studies are required to determine optimal management for PIC.