Multifocal choroiditis and punctate inner choroidopathy have long left clinicians scratching their heads over whether they are two distinct diseases or manifestations of the same condition. However, a new study in the American Journal of Ophthalmology found they are indeed two distinct clinical conditions and can be correctly diagnosed by lesion location and intraocular inflammation.
The multi-center study used a clinical database of 343 eyes of 185 subjects with diagnoses of multifocal choroiditis or punctate inner choroidopathy in the UK and Israel. The investigation used cluster analysis to distinguish between the two conditions.
Eyes were observed for approximately five years by masked observers who were unaware of the original diagnoses. The participants ranged in age from 11 to 89 with a baseline best-corrected visual acuity of 2.3 to -0.2 (logMAR). The majority of patients were females (82%) and 74% were myopic, with a refractive error range of +3.00D to -17.00D for the group. Cluster analysis prioritized clinical criteria of chorioretinal lesion location and intraocular inflammation and identified two distinct phenotype clusters resembling the original descriptions of multifocal choroiditis and punctate inner choroidopathy.
During the five-year observation period, the initial clinical diagnosis remained stable for the vast majority of eyes, and only one eye (0.3%) changed diagnosis from punctate inner choroidopathy to multifocal choroiditis due to newly developed peripheral lesions. The study also found distinct characteristics between the groups, including the development of choroidal neovascularization and different treatment approaches
This classification approach could be helpful in diagnosing and managing uveitis, the researchers noted.
|Gilbert RM, Niederer RL, Kramer M, et al. Differentiating multifocal choroiditis and punctate inner choroidopathy: a cluster analysis approach. Am J Ophthalmol. February 3, 2020. [Epub ahead of print].|