Puncta Inner Choroidopathy (PIC) Choroidal Inflammation, Neovascularization (CNV), Treatment

👁 “Punctate Inner Choroidopathy (PIC) – When Young Myopic Women See White Spots”

PIC is a rare inflammatory white dot syndrome that primarily affects young, myopic females,
causing multiple white-yellow lesions in the posterior pole without anterior uveitis or vitreous involvement.
Its main threat is the development of choroidal neovascularization (CNV), which can significantly impair vision.

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✅ Key Clinical Summary of PIC

FeatureDetails

Patient Demographic	Young myopic females (16–40 yrs)
Laterality	Often bilateral but asymmetric
Symptoms	Blurred vision, photopsia, scotomas
Fundus Findings	White punctate lesions in posterior/mid-periphery
→ become scars + pigment changes over time
CNV Risk	25–69%, associated with poor visual outcome
Imaging	FAG: early hyper → late stain
ICG: hypofluorescent spots
OCT: RPE and photoreceptor disruption
Electrophysiology	MfERG shows decreased response in scotoma area
Treatment
– Observation if stable
– Steroids (PSTA/IVTA/oral) for active lesions
– Anti-VEGF, photodynamic therapy, or immunosuppression if CNV develops
Prognosis	Good if CNV absent; 80% retain ≥20/25 vision
Poor with CNV-related macular scarring