Distinct Associations of Incident Choroidal Neovascularization and Focal Choroidal Excavation in Multifocal Choroiditis and Punctate Inner Choroiditis.

Abstract

Purpose: To evaluate associations of baseline OCT biomarkers, high myopia, and longitudinal choroidal thickness change with incident choroidal neovascularization (CNV) and focal choroidal excavation (FCE) in idiopathic multifocal choroiditis (MFC) and punctate inner choroiditis (PIC).

Methods: This retrospective single-center cohort included 49 patients and 98 longitudinal eye records. Incident analyses were restricted to 71 clinically affected eyes and excluded eyes with the corresponding complication at baseline. All OCT examinations were acquired with Heidelberg Spectralis spectral-domain OCT, and Follow-Up mode was used for scan relocation. Eye-level associations were estimated using generalized estimating equations with clustering by patient.

Results: Among 71 clinically affected eyes, CNV was present at baseline in 46 eyes and developed during follow-up in 12/25 affected eyes without baseline CNV (48.0%). FCE was present at baseline in 12 eyes and developed during follow-up in 40/59 affected eyes without baseline FCE (67.8%). Baseline RPE/Bruch's membrane complex disruption was associated with incident CNV (adjusted OR, 10.8; 95% CI, 1.4-81.0; p = 0.021), whereas OPL elevation was not (adjusted OR, 3.6; 95% CI, 0.6-21.1; p = 0.162). Incident FCE was associated with high myopia (adjusted OR, 12.1; 95% CI, 1.8-81.8; p = 0.011) and greater longitudinal choroidal thickness reduction (adjusted OR, 1.04 per 1% reduction; 95% CI, 1.001-1.081; p = 0.043).

Conclusions: In clinically affected MFC/PIC eyes, baseline RPE/Bruch's membrane complex disruption was associated with incident CNV, while high myopia and greater longitudinal subfoveal choroidal thickness reduction were associated with incident FCE. These retrospective associations do not establish lesion-level causality or mechanism.