Abstract
Purpose To investigate the role of systemic corticosteroids in the treatment of sight-threatening choroidal neovascularisation (CNV) in patients with punctate inner choroidopathy (PIC) and multifocal inner choroiditis (MIC).
Methods Twelve eyes of 10 patients with evidence of PIC or MIC with recent visual symptoms were identified. All eyes had CNV within the foveal avascular zone on fundus fluorescein angiography (FFA). Systemic oral prednisolone at an initial dose of 1 mg/kg (60-80 mg) was given for 3-5 days and the dose was subsequently tapered. Changes in best corrected visual acuity and leakage on FFA were recorded during follow-up. Systemic side-effects of the corticosteroids were monitored.
Results In 10 of 12 eyes vision improved or stabilised. Leakage on FFA resolved in 9 eyes and was reduced in 3. Four patients required more than one course of oral corticosteroids. One patient was maintained on low-dose oral corticosteroids for recurrent CNV activity. No systemic complications from the treatment were observed.
Conclusion A course of oral corticosteroids in healthy young patients with subfoveal CNV in PIC or MIC may reduce subretinal vascular leakage and stabilise vision when no other proven treatment option is available.
Similar content being viewed by others
Article PDF
References
Watzke RC, Packer AJ, Folk JC, Benson WE, Burgess D . Punctate inner choroidopathy. Am J Ophthalmol 1984;98:572–84.
Eldlam B, Sener C . Punctate inner choroidopathy and its differential diagnosis. Ann Ophthalmol 1991;23:153–8.
Dreyer RF, Gass JDM . Multifocal choroiditis and panuveitis: a syndrome that mimics ocular histoplasmosis. Arch Ophthalmol 1984;102:1776–84.
Brown J, Folk JC, Chittaranjan VR, Kimura AE . Visual prognosis of multifocal choroiditis, punctate inner choroidopathy, and the diffuse subretinal fibrosis syndrome. Ophthalmology 1996;103:1100–5.
Deutsch TA, Tessler HH . Inflammatory pseudohistoplasmosis. Ann Ophthalmol 1985;17:461–5.
Olk RJ, Burgess DB, McCormick PA . Subfoveal and juxtafoveal subretinal neovascularisation in the presumed ocular histoplasmosis syndrome. Ophthalmology 1984;91:1592–602.
Bressler SB, Bressler NM, Fine SL, et al. Natural course of choroidal neovascular membranes within the foveal avascular zone in senile macular degeneration. Am J Ophthalmol 1982;93:157–63.
Macular Photocoagulation Study Group. Argon laser photocoagulation for senile macular degeneration: results of a randomised clinical trial. Arch Ophthalmol 1982;100:912–8.
Macular Photocoagulation Study Group. Argon laser photocoagulation for ocular histoplasmosis: results of a randomised clinical trial. Arch Ophthalmol 1983;101:1347–57.
Macular Photocoagulation Study Group. Argon laser photocoagulation for idiopathic neovascularisation: results of a randomised clinical trial. Arch Ophthalmol 1983;101:1358–61.
Macular Photocoagulation Study Group. Argon laser photocoagulation for neovascular maculopathy: three-year results from randomised clinical trials. Arch Ophthalmol 1986;104:694–701.
Macular Photocoagulation Study Group. Krypton laser photocoagulation for neovascular lesions of ocular histoplasmosis: results of a randomised clinical trial. Arch Ophthalmol 1987;105:1499–507.
Macular Photocoagulation Study Group. Krypton laser photocoagulation for neovascular lesions of age-related macular degeneration: results of a randomised clinical trial. Arch Ophthalmol 1990;108:816–24.
Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration. Arch Ophthalmol 1991;109:1220–31.
Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: updated findings from two clinical trials. Arch Ophthalmol 1993;111:1200–9.
Thomas MA, Grand G, Williams DF, et al. Surgical management of subfoveal choroidal neovascularisation. Ophthalmology 1992;99:952–68.
Connor TB, Wolf MD, Arrindell EL, Mieler WF . Surgical removal of an extrafoveal fibrotic choroidal neovascular membrane with foveal serous detachment in age-related macular degeneration. Retina 1994;2:125–9.
Chakravarthy U, Houston RF, Archer DB . Treatment of age-related subfoveal neovascular membranes by teletherapy: a pilot study. Br J Ophthalmol 1993;77:265–73.
Fung W . Interferon alpha-2α for treatment of age-related macular degeneration. Am J Ophthalmol 1991;112:349–50.
Gillies MC, Sarks JP, Beaumont PE, et al. Treatment of choroidal neovascularisation in age-related macular degeneration with interferon alpha-2α and alpha-2β. Br J Ophthalmol 1993;77:759–65.
Chan CK, Kempin SJ, Noble SK, Palmer GA . The treatment of choroidal neovascular membranes by alpha interferon: an efficacy and toxicity study. Ophthalmology 1994;101:289–300.
Chisholm IH . The prospects of new treatments in age-related macular degeneration. Br J Ophthalmol 1993;12:757–8.
Folkman J, Ingber DE . Angiostatic steroids: method of discovery and mechanism of action. Ann Surg 1987;206:374–83.
DiAmato RJ, Adamis AP . Angiogenisis inhibition in age-related macular degeneration. Ophthalmology 1995;102:1261–2.
Schlaegel TF . Corticosteroids in the treatment of ocular histoplasmosis. Int Ophthal Clin 1993;23:111–23.
Teeters VW, Bird AC . The development of neovascularisation of senile disciform macular degeneration. Am J Ophthalmol 1973;76:1–18.
Ishibashi T, Koichiro M, Sorgente N, et al. Effects of intravitreal administration of steroids on experimental subretinal neovascularisation in the subhuman primate. Arch Ophthalmol 1985;103:708–11.
Penfold PL, Gyory JF, Hunyor AB, Billson FA . Exudative macular degeneration and intravitreal triamcinolone: a pilot study. Aust NZ J Ophthalmol 1995;23:293–8.
Crum R, Szabo S, Folkman J . A new class of steroids inhibits angiogenesis in the presence of heparin or a heparin fragment. Science 1985;230:1375–8.
Casey R, William WL, Adamis AP . Ocular angiogenesis. In: Albert DM, Jakobiec FA, editors. Principles and practice of ophthalmology: basic sciences. Philadelphia: WB Saunders. 1994:1100–7.
Lincoff H, Kreissig I, Hahn YS . A temporary balloon buckle for the treatment of small retinal detachments. Ophthalmology 1979;86:586–92.
Pavan PR, Margo CE . Submacular neovascular membrane and focal granulomatous inflammation. Ophthalmology 1996;103:586–9.
Morgan CM, Schatz H . Recurrent multifocal choroiditis. Ophthalmology 1986;93:1138–17.
Doran RML, Hamilton AMP . Disciform macular degeneration in young adults. Trans Ophthalmol Soc UK 1982;102:471–9.
Cantrill HL, Folk JC . Multifocal choroiditis associated with progressive subretinal fibrosis. Am J Ophthalmol 1986;101:170–80.
Palestine AG, Nussenblatt RB, Parver LM, Knox DL . Progressive subretinal fibrosis and uveitis. Br J Ophthalmol 1984;68:667–73.
Author information
Authors and Affiliations
Additional information
Presented in part at the Royal College of Ophthalmologists Annual Meeting, Birmingham, England, May 1995
The authors had no proprietary interest in any materials used in this study
Rights and permissions
About this article
Cite this article
Flaxel, C., Owens, S., Mulholland, B. et al. The use of corticosteroids for choroidal neovascularisation in young patients. Eye 12, 266–272 (1998). https://doi.org/10.1038/eye.1998.62
Issue Date:
DOI: https://doi.org/10.1038/eye.1998.62
Keywords
This article is cited by
-
Outcomes of adalimumab therapy in refractory punctate inner choroidopathy and multifocal choroiditis
Graefe's Archive for Clinical and Experimental Ophthalmology (2022)
-
Choroidale Neovaskularisation infolge einer „punctate inner choroidopathy“, dargestellt mittels optischer Kohärenztomographie-Angiographie
Der Ophthalmologe (2021)
-
Peripapillary choroidal neovascularisation in the context of ocular syphilis is sensitive to combination antibiotic and corticosteroid treatment
International Ophthalmology (2013)