Systemic Immunosuppression and Secondary Choroidal Neovascularisation in Patients with Punctate Inner Chorioretinopathy

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.