gms | German Medical Science

Background: The benefit of immunosuppression in punctate inner choroidopathy (PIC) remains debated. This study investigates the long-term effects of various immunomodulatory therapies on retinal atrophy progression and visual acuity (VA) outcomes using fundus autofluorescence (FAF) imaging.

Methods: A retrospective, single-center analysis was performed on 28 PIC patients (56 eyes, mean age 44.4 years) with a mean follow-up of 34 months (range: 8–64). A semi-automated image analysis workflow was applied to detect atrophy progression in FAF images (Zeiss Clarus 700, Carl Zeiss Meditec AG, Berlin). VA was recorded in logMAR. Patients were divided into four treatment groups: no therapy, conventional, biological or combined disease-modifying antirheumatic drugs (10 without therapy, 6 on cDMARDs, 6 on bDMARDs, and 6 on c/bDMARDs).

Results: Mean baseline VA for the treated cohort was 0.24 ± 0.5 logMAR and 0.34 ± 0.6 logMAR for the untreated cohort, respectively. Among the immunosuppressed patients (n=18), 19/36 eyes showed lesion progression. The lowest progression rate was observed in the c/bDMARD group (4/12 eyes). The non-immunosuppressed group (n=10) had 9/20 eyes with progression. VA remained stable in both cohorts at final follow up: 0.25 ± 0.6 logMAR (untreated) vs. 0.35 ± 0.6 logMAR (treated).

Conclusion: Immunosuppressive therapy may affect lesion progression in PIC. However, despite structural changes, VA remained stable across groups. These findings support further exploration of tailored immunomodulatory strategies in PIC, which can be monitored using a semi-automated algorithm for FAF image analysis.