A Distinct Pattern of Choroidal Lesions in Multifocal Choroiditis and Pan-uveitis Determined by Heatmap Analysis
Jong Park, MD
Park, Jong; Halim, Muhammad; Uludag, Gunay; Onghanseng, Neil; Sredar, Nripun; Sepah, Yasir; Nguyen, Quan
(All): Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, United States.
Purpose: There remains much debate about the clinical distinctions among punctate inner choroidopathy (PIC), multifocal choroiditis (MFC), and multifocal choroiditis and panuveitis (MCP). A heatmap analysis of the choroidal lesions in patients diagnosed with PIC, MFC, or MCP was performed to determine if there were any distinguishing features among these uveitic entities.
Methods: Retrospective review of medical records was conducted using STRIDE (clinical data warehouse containing HIPPA complaint patient information) at Stanford University Hospital. Patients with ICD-9/ICD-10 codes consistent with PIC, MFC, and MCP between 2008-2018 were identified. Fundus photographs for all affected eyes were compiled and placed on a standardized template. Lesions were marked by trained graders of an ophthalmic reading center in a standardized fashion. A heatmap was generated by combining marked lesions from all templates.
Results: A total of 19 patients (32 eyes) were identified with a diagnosis of PIC, MFC, or MCP. 3 of 19 (16%) had a diagnosis of PIC, 9 of 19 (47%) had a diagnosis of MFC, and 7 of 19 (37%) had a diagnosis of MCP. The mean age was 40.6 years at the time of initial diagnosis. 16 of 19 (84%) were female, 3 of 19 (16%) were male. 13 of 19 (68%) had bilateral involvement, 6 of 19 (32%) had unilateral involvement. Heatmap analysis revealed three distinct patterns of fundus lesions: predominantly posterior, predominantly peripheral, and combined posterior and peripheral. All patients with a diagnosis of MCP demonstrated the combined pattern of involvement with lesions in both the posterior pole and the periphery.
Conclusions: There are three patterns of choroidal lesions identified in PIC, MFC, and MCP: predominantly posterior, predominantly peripheral, or combined posterior and peripheral. All patients with MCP demonstrated a combined pattern of choroidal lesions, which suggests that the presence of inflammatory cells in the anterior or posterior chambers as detected in MCP may cause more extensive damage to the choroid. Our work supports the idea that these three uveitic entities may represent a continuum of the same inflammatory process, with MCP being the most extensively involved.