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Immunosuppressants and/or antivascular endothelial growth factor inhibitors in punctate inner choroidopathy? Follow-up results with optical coherence tomography angiography
  1. Dominika Pohlmann,
  2. Uwe Pleyer,
  3. Antonia M Joussen,
  4. Sibylle Winterhalter
  1. Department of Ophthalmology, Charité – Universitätsmedizin Berlin,corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  1. Correspondence to Dr Dominika Pohlmann, Department of Ophthalmology, Charité – University Medicine Berlin, Berlin 13353, Germany; dominika.pohlmann{at}charite.de

Abstract

Purpose To report the effectiveness of treatment with antivascular endothelial growth factor (VEGF)-inhibitor and/or immunosuppressants in punctate inner choroidopathy (PIC) using standard imaging modalities and optical coherence tomography angiography (OCTA) over a time period of 16 months.

Methods In this prospective, unmasked, single-centre study, 23 individuals with PIC underwent imaging with spectral domain OCT, fluorescein angiography, indocyanine green angiography and OCTA. Two groups were formed based on systemic treatment. In case of choroidal neovascularisation (CNV) activity, intravitreal anti-VEGF injections were carried out in both groups.

Results Group I included 12 patients (24 eyes) with 18 affected eyes (75%) who did not receive any systemic therapy at baseline. Group II contained 11 patients (22 eyes) who started systemic immunosuppressive therapy on average 2 years before baseline. All eyes with recurrence of CNV or residual fluid (group I: seven eyes; group II: six eyes) received anti-VEGF agents. Group I showed a significant reduction of CNV size (p=0.0078), as well as a decrease of fluid retention (p=0.0078) on OCTA after anti-VEGF injection. Group II did not demonstrate any significant reduction of CNV size, vessel shape or fluid retention post injection. But overall, fluid accumulation was significantly lower in group II (median=0.03 mm2) than in group I (median=0.32 mm2) (p=0.0028).

Conclusion Immunosuppressants in addition to anti-VEGF agents showed a significant reduction of fluid accumulation, that is, reduced disease activity. We conclude that there is a benefit and effectiveness of immunosuppressants to control inflammatory secondary CNV in PIC.

  • imaging
  • inflammation
  • neovascularisation
  • retina
  • treatment medical

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Footnotes

  • Contributors Conception and design: DP and SW. Analysis and interpretation: DP. Data Collection: DP, SW and UW. Review: SW, UP and AMJ. Overall responsibility: DP.

  • Funding DP is participant in the BIH Charité Clinician Scientist Program funded by the Charité-Universitätsmedizin Berlin and the Berlin Institute of Health.

  • Disclaimer DP has served as consultant for Allergan. UP has served as principal investigator or consultant for: Abbvie, Alcon, Allergan, Novartis, Santen, Thea. AMJ has served as principal investigator or consultant for: Allergan, Novartis, Bayer, OD-OS, Heidelberg engineering. SW has served as consultant for: Allergan, Novartis, Bayer, MSD, Heidelberg engineering. None of the authors has a direct proprietary interest in any of the products used in this study.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval This single-centre, prospective,unmasked study was performed in accordance with the Declaration of Helsinkiand approved by the local ethics committee (EA4/055/16).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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