OSLI Retina

November 2019

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November 2019 · Vol. 50, No. 11 675 ■ C L I N I C A L S C I E N C E ■ The Nature and Frequency of Outer Retinal Disruption in Idiopathic Multifocal Choroiditis Associated With Persistent Fundus Hyperautofluorescence Talia R. Kaden MD; Sarra Gattoussi, MD; Rosa Dolz-Marco MD, PhD; Chandrakumar Balaratnasingam, MD, PhD; Lawrence A. Yannuzzi, MD; K. Bailey Freund, MD BACKGROUND AND OBJECTIVE: To describe the prevalence and anatomic correlates for hyperauto- fluorescence related to outer retinal disruption in eyes with multifocal choroiditis (MFC). PATIENTS AND METHODS: Retrospective review of MFC patients. RESULTS: Fifty-nine eyes from 37 patients were ana- lyzed. Multimodal imaging was utilized to identify nine eyes (15.2%) of six patients with either tran- sient (Group 1) or persistent (Group 2) regions of hyperautofluorescence associated with ellipsoid zone (EZ) disruption over intact retinal pigment ep- ithelium (RPE). Group 1 included four eyes (6.8%) of three patients in which the hyperautofluores- cence and EZ loss resolved within a few months (range: 28 days to 125 days) and had intact overly- ing outer nuclear (ONL) and outer plexiform layers (OPL) (mean follow-up: 1.3 years). Group 2 includ- ed five eyes (8.5%) of three patients with regions of permanent EZ disruption associated with absent or reduced ONL and OPL (mean follow-up: 4.6 years). CONCLUSIONS: Hyperautofluorescence correlating with EZ disruption over intact RPE is a rare occur- rence in MFC. Evaluating outer retinal integrity by optical coherence tomography may help identify eyes with potential for EZ restoration, which may have implications regarding treatment strategies. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:675-683.] INTRODUCTION Idiopathic multifocal choroiditis (MFC) is an inflammatory disease of unknown etiology with a predilection for otherwise healthy, middle-aged, myopic females. 1-4 There is considerable variation in the clinical manifestations of MFC; however, most cases are typified by multiple, punched-out chorioretinal lesions ranging from 50 µm to 350 µm involving the posterior pole and the retinal periph- ery. 4-8 Other manifestations of MFC include vitre- ous or anterior chamber inflammation, peripheral curvilinear scars, and secondary choroidal neovas- cularization (NV). 4-7 Multimodal imaging (MMI) has improved our understanding of the pathophysi- ologic mechanisms underlying MFC. Spaide et al. were the first to identify an associa- tion between visual field loss and the OCT finding From the Department of Ophthalmology, New York University School of Medicine, New York (TRK, KBF); Vitreous Retina Macula Consultants of New York, New York (TRK, SG, LAY, KBF); The LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York (TRK, SG, LAY, KBF); the Department of Ophthalmology, Manhattan Eye Ear and Throat Hospital, New York (TRK); Unit of Macula, Oftalvist Clinic, Valencia, Spain (RDM); Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia (CB); Lions Eye Institute, Nedlands, Western Australia, Australia (CB); and the Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia (CB). Originally submitted October 1, 2018. Revision received February 10, 2019. Accepted for publication March 25, 2019. Presented as a poster at ARVO 2017 in Baltimore Supported by The LuEsther T. Mertz Retinal Research Center; Manhattan Eye, Ear, and Throat Hospital, New York, NY; and the Macular Foundation, Inc., New York, NY. The funding organizations had no role in the design or execution of this research. Dr. Freund is a consultant for Optovue, Genentech, Zeiss, Heidelberg Engi- neering, Novartis, Allergan, and Optos and receives research support from Genentech/Roche. Dr. Yannuzzi receives an honorarium from Genentech for the retina fellowship teaching program. Dr. Dolz-Marco has received research support from Novartis, Genentech, Roche, and Heidelberg Engi- neering. The remaining authors report no relevant financial disclosures. Address correspondence to K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022; email: kbfnyf@aol.com. doi: 10.3928/23258160-20191031-02

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