Optical Coherence Tomography Angiography Changes in Choroidal Vasculature following Treatment in Punctate Inner Choroidopathy

ABSTRACT

Purpose: To describe the changes seen on optical coherence tomography angiography [OCTA] in patients with PIC following immunosuppressive therapy.

Methods: We reviewed serial OCTA scans from five consecutive PIC patients (5 eyes) with at least 3 months of follow-up, who underwent imaging before and after immunosuppressive therapy. Using ImageJ, superficial and deep retinal vasculature were analyzed for vessel area and foveal avascular zone. Choriocapillaris layer was analyzed for flow signal loss.

Results: Five out of five patients received an orbital floor triamcinolone acetonide injection as the initial treatment for periods of activity. Mean choriocapillaris (CC) flow void area obtained after immunosuppressive therapy was significantly lower than the mean CC flow void area obtained prior to treatment (Pre-treatment: 0.270 vs Post-treatment: 0.144; p = .0068). In 2 out of 2 patients with longitudinal visual field testing, CC flow voids were spatially associated with visual field defects, and immunosuppressive therapy was associated with reduced CC flow void area and improved visual function.

Conclusion: OCTA can detect alterations in choriocapillaris flow. Longitudinal follow-up demonstrates a centripetal restoration of choriocapillaris flow in response to immunosuppressive therapy. OCTA may be a useful adjunct for monitoring and evaluating treatment of PIC

KEYWORDS:

• Optical coherence tomography angiography
• punctate inner choroidopathy
• choriocapillaris
• flow void
• inflammation
• periocular steroid
• immunosuppression

Declaration of Interest

None of the authors have any conflicting interests to disclose. The authors alone are responsible for the content and writing of the paper.

Summary statement

In a clinical study of patients with active punctate inner choroidopathy disease, optical coherence tomography angiography detected improvements in choriocapillaris perfusion after treatment with local and systemic immunosuppressive therapy.

Additional information

Funding

The funding for this study was provided by NEI Intramural Research Program which is the  internal research program of the National Institutes of Health.