American journal of ophthalmology · 2026
Optical Coherence Tomography (OCT) Features of Inactive Multifocal Choroiditis With Panuveitis and Punctate Inner Choroidopathy (MFCPU/PIC) Lesions.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Trinco Andrea, Ferdeghini Diego, Zicarelli Federico, Oldani Marta, Sadda SriniVas, Staurenghi Giovanni, Agarwal Aniruddha, Invernizzi Alessandro
Аннотация
PURPOSE: To identify optical coherence tomography (OCT) biomarkers of inactive multifocal choroiditis with panuveitis and punctate inner choroidopathy (MFCPU/PIC) and to compare them with atrophic chorioretinal scars secondary to inflammatory and infectious mimickers.
DESIGN: Cross-sectional observational study.
SUBJECTS: Fifty-nine patients with inactive chorioretinal atrophic lesions, including 27 patients (57 lesions) with MFCPU/PIC and 32 patients (49 lesions) with non-MFCPU/PIC etiologies (sarcoidosis, tuberculosis, syphilis, serpiginous choroiditis, APMPPE, birdshot chorioretinopathy, and ocular toxoplasmosis), evaluated at Luigi Sacco Hospital (Milan, Italy).
METHODS: All patients underwent multimodal imaging including color fundus photography, near-infrared reflectance, fundus autofluorescence, and spectral-domain OCT (SD-OCT), with additional high-resolution OCT (HR-OCT). Lesions were randomly sampled (maximum 3 per eye). Quantitative OCT measurements included retinal pigment epithelium atrophy size (RPE-AS), Bruch's membrane defect size (BrM-HS), and choroidal thickness coefficient (CTC). Structural alterations across retinal layers were graded. Regression models with cluster-robust standard errors were used to account for intrapatient clustering.
MAIN OUTCOME MEASURES: Frequency of Bruch's membrane (BrM) disruption and inner retinal layer herniation; relationship between RPE-AS and BrM-HS; choroidal involvement; agreement between SD-OCT and HR-OCT.
RESULTS: BrM disruption was observed in 94.7% of MFCPU/PIC lesions compared with 6.1% of controls (P < .001), remaining strongly associated with MFCPU/PIC independently from age and RPE-AS. Inner nuclear layer (INL) herniation was significantly more frequent in MFCPU/PIC lesions (57.9% vs 4.3%, P < .001). RPE atrophy was present in all lesions, while BrM defects were consistently smaller and concentrically localized within areas of RPE atrophy. RPE-AS and BrM-HS were positively correlated (β = 0.36, P = .002). MFCPU/PIC lesions demonstrated lower CTC values (P < .001) and more frequent focal choroidal excavation. Agreement between SD-OCT and HR-OCT was good (κ = 0.60), with no added diagnostic yield of HR-OCT.
CONCLUSIONS: Bruch's membrane disruption and inner retinal layer herniation into focal choroidal excavation are highly characteristic OCT features of inactive MFCPU/PIC. These findings may facilitate diagnosis in the absence of active inflammation and support a distinctive lytic inflammatory mechanism involving the outer retina, BrM, and choroid.
DESIGN: Cross-sectional observational study.
SUBJECTS: Fifty-nine patients with inactive chorioretinal atrophic lesions, including 27 patients (57 lesions) with MFCPU/PIC and 32 patients (49 lesions) with non-MFCPU/PIC etiologies (sarcoidosis, tuberculosis, syphilis, serpiginous choroiditis, APMPPE, birdshot chorioretinopathy, and ocular toxoplasmosis), evaluated at Luigi Sacco Hospital (Milan, Italy).
METHODS: All patients underwent multimodal imaging including color fundus photography, near-infrared reflectance, fundus autofluorescence, and spectral-domain OCT (SD-OCT), with additional high-resolution OCT (HR-OCT). Lesions were randomly sampled (maximum 3 per eye). Quantitative OCT measurements included retinal pigment epithelium atrophy size (RPE-AS), Bruch's membrane defect size (BrM-HS), and choroidal thickness coefficient (CTC). Structural alterations across retinal layers were graded. Regression models with cluster-robust standard errors were used to account for intrapatient clustering.
MAIN OUTCOME MEASURES: Frequency of Bruch's membrane (BrM) disruption and inner retinal layer herniation; relationship between RPE-AS and BrM-HS; choroidal involvement; agreement between SD-OCT and HR-OCT.
RESULTS: BrM disruption was observed in 94.7% of MFCPU/PIC lesions compared with 6.1% of controls (P < .001), remaining strongly associated with MFCPU/PIC independently from age and RPE-AS. Inner nuclear layer (INL) herniation was significantly more frequent in MFCPU/PIC lesions (57.9% vs 4.3%, P < .001). RPE atrophy was present in all lesions, while BrM defects were consistently smaller and concentrically localized within areas of RPE atrophy. RPE-AS and BrM-HS were positively correlated (β = 0.36, P = .002). MFCPU/PIC lesions demonstrated lower CTC values (P < .001) and more frequent focal choroidal excavation. Agreement between SD-OCT and HR-OCT was good (κ = 0.60), with no added diagnostic yield of HR-OCT.
CONCLUSIONS: Bruch's membrane disruption and inner retinal layer herniation into focal choroidal excavation are highly characteristic OCT features of inactive MFCPU/PIC. These findings may facilitate diagnosis in the absence of active inflammation and support a distinctive lytic inflammatory mechanism involving the outer retina, BrM, and choroid.