Distinct Patterns of Choroidal Lesions in Punctate Inner Choroidopathy and Multifocal Choroiditis Determined by Heatmap Analysis

Abstract

Purpose: A heatmap analysis of choroidal lesions in patients with punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) with or without uveitis was performed to determine if there were any distinguishing features among these uveitic entities.

Methods: Retrospective review of medical records was conducted at the Byers Eye Institute, Stanford. Fundus photographs were masked and placed on a standardized template. Lesions were identified and heatmaps were generated in a standardized fashion.

Results: 30 eyes were identified with PIC or MFC. Heatmap analysis revealed three distinct patterns of fundus lesions: posterior, peripheral, and combined. All patients with PIC had the posterior pattern. Patients with MFC had the peripheral or combined pattern, and all patients with MFC with uveitis had the combined pattern.

Conclusion: Three patterns of fundus lesions were identified in patients with PIC and MFC. PIC and MFC may represent two separate disease entities with distinct phenotypes of choroidal lesions.

Keywords: Heatmap; multifocal choroiditis; multifocal choroiditis and panuveitis; punctate inner choroidopathy.

Figure 1.

Template for marking fundus lesions. A) The optic disc (small blue ring) and the fifth circle from the center which approximated the macula (large red circle) were marked on the template. B) Representative fundus photograph placed on the template in a standardized fashion. The fovea was matched to the center of the template, and the optic disc was matched to the blue ring to the right or left of center according to laterality of the fundus photograph. C) Lesions were marked on the template. D) Marked templates were then combined to generate heatmaps.

Figure 2.

Heatmap of all fundus lesions in patients diagnosed with PIC or MFC. The lesions of 30 eyes and 560 total lesions were combined to show a dense cluster of lesions in the posterior pole, relatively fewer lesions in the mid periphery, and a large number of lesions in the far periphery. Color scale 0 (black) to 9 (white).

Figure 3.

A) Heatmap showing a posterior pattern of lesions. 12 eyes with greater than 50% of lesions in the posterior pole totaling 88 lesions were used to generate a heatmap demonstrating a dense cluster of lesions in the posterior pole and relatively few lesions in the periphery. Color scale 0 (black) to 5 (white). B) Representative fundus photograph of an eye with a posterior pattern.

Figure 4.

A) Heatmap showing a peripheral pattern of lesions. 5 eyes with no lesions in the posterior pole totaling 103 lesions were used to generate a heatmap demonstrating scattered lesions in the mid to far periphery. Color scale 0 (black) to 2 (white). B) Representative fundus photograph of an eye with a peripheral pattern.

Figure 5.

A) Heatmap showing a combined pattern of lesions. 13 eyes with greater than 50% of lesions outside the posterior pole totaling 369 lesions were used to generate a heatmap demonstrating a dense cluster of lesions in both the posterior pole and the periphery. Color scale 0 (black) to 5 (white). B) Representative fundus photograph of an eye with a combined pattern.