Rachael Niederer1,3, Rose Gilbert1,2, Sue Lightman1,2, Oren Tomkins-Netzer1,2

Purpose: To examine a large cohort of subjects with punctate inner choroidopathy (PIC) looking at risk factors for development of choroidal neovascular membrane and visual loss.

Methods: Cross-sectional study of all subjects with PIC seen at Moorfields Eye Hospital between 1996 and 2016.

Results: 203 subjects (318 eyes) were included in the study. Median follow up was 8.4 years. Subjects were predominantly young (median 32.9 years), myopic (91.5%), female (87.2%) and Caucasian (75.9%). Disease was bilateral at presentation in 115 subjects (56.7%) and choroidal neovascular membrane (CNVM) was present at presentation in 126 subjects (62.1%) and in 152 eyes (47.8%). During follow up, new CNVM occurred in 58 eyes. Increased risk of developing CNVM was associated with CNVM in the fellow eye (p<0.0005, HR 2.732) and previous oral corticosteroid treatment was associated with halving of the risk of developing CNVM (p=0.035, HR 0.446). Out of 142 eyes with active CNVM seen during the study period, 78 were treated with oral corticosteroids, and 67 were treated with antiVEGF therapy. Subjects treated with antiVEGF had better visual outcomes (p=0.018). Moderate visual loss (?6/15) occurred in 40 eyes (12.6%) and severe visual loss (?6/60) occurred in 49 eyes (15.4%). Conclusions: Whilst 72% of subjects with PIC achieve visual acuity of 20/40 or better, visual loss is common, predominantly secondary to late development of CNVM. Initial treatment with oral corticosteroid may help to reduce the risk of CNVM development, and antiVEGF therapy for CNVM was associated with better clinical outcomes.