Multifocal Choroiditis (MFC) and Punctate Inner Choroidopathy (PIC)

Multifocal choroiditis (MFC) and punctate inner choroidopathy (PIC) form a spectrum of conditions characterised by the presence of multiple small, circular inflammatory lesions within the RPE and choroid. Over time these yellow-white lesions develop a pigmented border.

This condition is most commonly bilateral and affects young females most frequently. Vision may be affected by epiretinal membrane, macular oedema, vitritis, choroidal neovascularisation or fibrotic scarring at the macula.

Acute MFC is typically accompanied by vitritis and often also inflammation in the anterior chamber. PIC is thought to be part of the spectrum of MFC and is a term used to describe a presentation limited to the posterior pole, consisting of small lesions and no vitritis or anterior chamber inflammation. Presumed ocular histoplasmosis syndrome is also considered to be part of this MFC spectrum.

OCT shows hyper-reflective material between the RPE and Bruch’s membrane with hyper-transmission of the signal through to the choroid. Sub-RPE deposits and disruption of the outer retinal layers may also be noted. Lesions appear hypo-fluorescent on FAF imaging, typically showing a border of hyper-fluorescence in the acute stages, but becoming completely hypo-fluorescent over time.

Knickelbein, JE. Nida Sen, H. (2016) Multimodal Imaging of the White Dot Syndromes and Related Diseases J Clin Exp Ophthalmol. 2016 June ; 7(3): .

Wong, E. Nivison-Smith, L. Assaad, NN. Kalloniatis, M. (2015). OCT and fundus autofluorescence enhances visualization of white dot syndromes. Optometry and Vision Science, 92(5):642-53.