This 59YO female initially had unilateral multifocal choroiditis (MFC) in her left eye. When we started seeing her in the mid-1990s, predating the anti-VEGF era, we battled multiple inflammatory macular neovascularizations (MNV).
Eventually, she developed subfoveal MNV and nasal subretinal fibrosis despite multiple thermal laser treatments, and her vision remains counting fingers OS.
Fourteen years later, she developed asymptomatic hypo and hyperpigmented lesions in her right eye similar to those of her left eye, and she remained 20/20 OD.
Initially treated with intravitreal Avastin for MNV, intravitreal triamcinolone was also added for new macular lesions.
Learning Points:
MFC occurs in otherwise healthy adults, often myopic and female. Findings include multifocal variably pigmented multifocal scars throughout the posterior pole and periphery.
Unlike ocular histoplasmosis, new scars and uveitis can be seen. Punctate inner choroidopathy most likely represents a continuum of MFC rather than a separate disease. MNV can be successfully managed with anti-VEGF therapy.
