J Korean Ophthalmol Soc.  2017 Nov;58(11):1282-1288. 10.3341/jkos.2017.58.11.1282.

Recurrence of Punctate Inner Choroidopathy with an Intravitreal Dexamethasone Implant

• Shin MH
• Kang HJ
• Chung IY

• KMID: 2395871
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1282

Abstract

PURPOSE
To report a case of punctate inner choroidopathy (PIC) treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment.
CASE SUMMARY
A 23-year-old highly myopic female who presented with PIC in her right eye was treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment including facial edema and sleep disturbances. Three months after the implant she complained of severe acute visual disturbances in her right eye. Her visual acuity was classified as hand movement. Choroidal neovascularization (CNV) was observed on optical coherence tomography and indocyanine green angiography revealed more multiple hypofluorescent lesions compared to the initial visit. Six months after the systemic steroid and intravitreal bevacizumab injection treatments, visual acuity in right eye improved and the CNV disappeared.
CONCLUSIONS
This report describes a case of PIC after, treatment with an intravitreal dexamethasone implant due to the side effects of systemic steroid treatment, which recurred with complications.

Keyword

Intravitreal bevacizumab; Intravitreal dexamethasone implant; Punctate inner choroidopathy; Systemic steroid

MeSH Terms

Angiography
Bevacizumab
Choroidal Neovascularization
Dexamethasone*
Edema
Female
Hand
Humans
Indocyanine Green
Recurrence*
Tomography, Optical Coherence
Visual Acuity
Young Adult
Bevacizumab
Dexamethasone
Indocyanine Green

Figure

• 

  Figure 1 Fundus photograph, optical coherence tomography (OCT), fluorescein angiography and indocyanine green angiography at initial visit. (A) Fundus photograph shows multiple, yellow, round lesions on posterior pole (dotted line is OCT section line). (B) Optical coherence tomography shows multiple irregular elevation of retinal pigment epithelium and photoreceptor. (C, D) Fluorescein angiography shows multiple hyperfluorescent lesions on posterior pole and indocyanine green angiography shows multiple hypofluorescent lesions on posterior pole (more prominent lesions on indocyanine green angiography).

• 

  Figure 2 Fundus photograph at initial visit, 1 month and 3 months later. (A) Fundus photograph at initial visit. (B) Fundus photograph at 1 month later shows more fainted and decreased number of lesions on posterior pole. (C) Fundus photograph at 3 months later shows more prominent and increased number of lesions on posterior pole.

• 

  Figure 3 Fundus photograph, optical coherence tomography (OCT) and indocyanine green angiography at dexamethasone implant injection, 2 months and 3 months after implant injection. (A–C) Fundus photograph at dexamethasone implant injection, 2 months and 3 months after implant injection. (D–F) OCT at dexamethasone implant injection, 2 months and 3 months after implant injection. (G, H) Indocyanine green angiography shows more confluent, increased number and enlarged lesions at 3 months after implant injection than initial visit.

• 

  Figure 4 Fundus photograph and optical coherence tomography (OCT) at 3 months and 6 months after implant injection. (A, B) Fundus photograph and OCT at 3 months after implant injection (dotted line is OCT section line). (C) Fundus photograph at 6 months after bevacizumab injection shows decreased activity of inflammation and subretinal fibrosis (dotted line is OCT section line). (D) Optical coherence tomography at 6 months after bevacizumab injection shows absorbed subretinal fluid and decreased choroidal neovascularization.

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