Characteristic Spectral-domain Optical Coherence Tomography Findings of Multifocal Choroiditis

Purpose: To compare the spectral-domain optical coherence tomography (SD-OCT) findings of the acute lesions of multifocal choroiditis (MFC) with those of new-onset myopic choroidal neovascularization (CNV).

Methods: Observational case series. A retrospective review comparing the SD-OCT findings of the acute lesions of MFC with those of early myopic CNV. Spectral-domain optical coherence tomography findings in two female patients and one male patient presenting with acute inflammatory lesions of MFC were compared with those of new-onset CNV in three patients with myopic macular degeneration. Each patient underwent a comprehensive eye examination, fundus photography, and fluorescein angiography on the initial visit. The patients underwent SD-OCT scanning at baseline and at follow-up visits using image registration and eye tracking.

Results: Spectral-domain optical coherence tomography imaging of the acute lesions of MFC showed drusenlike material between the retinal pigment epithelium and the Bruch membrane, presumed vitreous cells, and localized choroidal hyperreflectivity below the subretinal pigment epithelial material. These SD-OCT findings were not usually present in the eyes with myopic CNV. The subretinal pigment epithelial material corresponded to acute lesions found on color photographs and fluorescein angiography. The subretinal pigment epithelial material and choroidal hyperreflectivity appeared to improve after treatment with antiinflammatory or anti-vascular endothelial growth factor therapy. In contrast, SD-OCT in the patients with myopic CNV showed a very thin choroid, a posterior staphyloma, and a Type 2 (subretinal) neovascular pattern.

Conclusion: The acute lesions of MFC can be difficult to distinguish from myopic CNV based on clinical examination and fluorescein angiography. However, the inflammatory lesions of MFC can demonstrate characteristic SD-OCT findings not seen with myopic CNV. These SD-OCT findings may help to differentiate these two entities that typically require different treatments.