Purpose

Determine rate of growth retinal atrophy in autoinflammatory eye conditions treated with immunosuppression

Methods

A retrospective study on 12 patients (21 eyes) using fundus autofluorescence imaging to examine growth of retinal atrophy in autoinflammatory eye conditions. Mean follow-up was 9.6 years. Measurement of atrophic area was taken on presentation and consecutive follow up. The annual growth rate of progression was calculated and compared to non-inflammatory eye condition resulting in retinal atrophy.Type of immunosuppression and BCVA was documented. Patients were sub-categorised into 3 main conditions: punctate inner choroidopathy (PIC), multifocal choroiditis (MFCh), and serpiginous choroiditis (SCh). Myopic CNV patients were excluded.

Results

33 eligible patients were identified, 12 patients fulfilled the selection criteria. Average patient age was 65.4 years, 8 patients were male. PIC (7 eyes) had a growth of 1.31mm2/year. MFCh (6 eyes) a growth of 3.02mm2/year. SCh (7 eyes) a growth of 1.03mm2/year. Number of immunosuppressive agents was highest with SCh mean of 2.75. PIC a mean of 2.4 and MFCh a mean of 1. PIC had a total of 47 and SCh 38 anti-VEGF intravitreal injections.Visual outcomes were worst for SCh. 62.5% of patients had a reduction in visual acuity during follow up. 40% of PIC patients had reduced visual acuity and MFCh had no reduction in visual acuity.

Conclusions

Despite prolonged systemic immunosuppression inflammatory conditions continued to cause in situ inflammation with permanent damage to choroid and retina. Clinical outcomes were worst for SCh. PIC and MF performed better with less demand for systemic immunosuppressive therapy. Autofluorescence was valuable in charting long term response to treatment of patients with autoinflammatory eye conditions.