TRANSDIFFERENTIATION AND INTRACHOROIDAL MIGRATION OF MELANOTIC RETINAL PIGMENT EPITHELIUM IN PUNCTATE INNER CHOROIDITIS.

Purpose: The objective of this study was to report the multimodal imaging features of hyperpigmented chorioretinal lesions originating from the retinal pigment epithelium within punched-out lesions of punctate inner choroidopathy.

Methods: This was a retrospective case report. Multimodal imaging findings including fundus photography, optical coherence tomography, and optical coherence tomography-angiography were analyzed.

Results: A 49-year-old woman with myopic degeneration developed progressive lesions of punctate inner choroidopathy, requiring immunosuppressive therapy with adalimumab. Within the areas of punched-out chorioretinal atrophic lesions, the occurrence of hyperpigmented lesions was observed, which enlarged and extended into the choroid over a multiyear follow-up.

Conclusion: This case illustrates the development of pigmented choroidal lesions appearing to originate from the retinal pigment epithelium through transdifferentiation after previous chorioretinal inflammatory lesions. The introduction of adalimumab treatment may have activated the cellular migration of the retinal pigment epithelium. To the best of the authors' knowledge, this is the first report of intrachoroidal retinal pigment epithelium migration in punctate inner choroidopathy.