Acute zonal occult outer retinopathy in the fellow eye 5 years after presentation of punctate inner choroidopathy

Abstract

This case presents indirect evidence that PIC and AZOOR may have some common etiologic or pathogenic background.

Ocular Coherence Tomographic and Clinical Characteristics in Patients of Punctuate Inner Choroidopathy Associated with Zonal Outer Retinopathy

“…There have been several reports on patients developing zonal outer retinopathy, either in the same eye or in the fellow eye, after previous PIC attack. [2][3][4] Gass proposed that these AZOOR complex disorders (PIC, AZOOR, etc.) probably represent spectrums of a single disease.…”

“…1 Zonal outer retinal dysfunction beyond the area of choroidal lesions has been reported in cases of PIC and multifocal choroiditis (MFC). [2][3][4] There have been some studies on optical coherence tomography (OCT) [5][6] and indocyanine green angiographic findings 4 in PIC, and other isolated cases of occult outer retinopathy associated with MFC. 7 In this retrospective review of series cases, we describe the clinical, angiographic, electroretinographic (ERG), and serial OCT findings at the initial and convalescent phases before and after treatment in eyes of zonal occult outer retinopathy associated with PIC.…”

Idiopathic Multifocal Choroiditis/Punctate Inner Choroidopathy With Acute Photoreceptor Loss or Dysfunction Out of Proportion to Clinically Visible Lesions

“…2,5 Previous reports have noted MFC/PIC with photoreceptor attenuation beyond the chorioretinal lesions or have described MFC/PIC accompanied by enlarged blind spots. 9–11,13–18 Some authors have described this MFC/PIC variant as part of the AZOOR complex. 13,14,19 The original Gass case series, which first described AZOOR, included patients with MFC lesions.…”

“…9–11,13–18 Some authors have described this MFC/PIC variant as part of the AZOOR complex. 13,14,19 The original Gass case series, which first described AZOOR, included patients with MFC lesions. 20 Spaide et al reported 11 patients with MFC and blind spot enlargement and found that the scotomata correlated with the loss of the photoreceptor outer segments on SD-OCT. 16 Chen et al reported in their series of PIC patients that the scotomata seen in these patients also corresponded to the photoreceptor-loss visible on SD-OCT. 10 Kramer et al found that these areas of photoreceptor-loss in patients with MFC corresponded to hyperautofluorescence, which was also verified by reports from Jung et al and Freund et al 9,11,12 All these findings are consistent with our observations.…”

Diagnostic and Therapeutic Challenges

“…In 2004, Mathura et al10 described an 18-year-old man who developed acute posterior multifocal placoid pigment epitheliopathy followed 16 years later by MFC. Similarly, acute zonal occult outer retinopathy has been independently reported to occur in patients with a history of MFC,11 punctate inner choroiditis,12 and MEWDS 13. Hence, although this would be a first report of IRVAN occurring in a patient with birdshot chorioretinopathy, the patient does seem to satisfy the diagnostic criteria for the two conditions, and there are clear precedents for the sequential occurrence of two distinct uveitic syndromes in a single patient, although it has been suggested, at least by some of the conditions mentioned earlier forming a continuum or complex, and hence may not represent completely independent entities 14…”