Clinical Symptoms and Findings

The symptoms that connect multifocal choro-iditis to all other PICCPs are the photopsias. They are usually much more disturbing for the patient than in other PICCPs and their duration is protracted, being present also when there is no clinical evidence of reactivation of the disease. The patients also report scotomata. Multi-focal choroiditis can be bilateral, with involvement usually being asymmetric, or it can be unilateral and is then usually included in the subtype of punctate inner choroidopathy (PIC). Visual loss depends on the localization of the lesions and can be severe when lesions are close to the fovea. Visual field testing objectively identifies the scotomata the patients report and that are localized to the areas of fundus involvement.

Classically, only slight non-granulomatous anterior segment inflammation is present. Therefore if anterior granulomatous uveitis is present, a specific diagnosis, such as sarcoido-sis, syphilis or tuberculosis, has to be excluded. Cells in the vitreous can be found most of the time when the disease is active but can be absent in quiet disease.

On fundus examination, the typical lesions are small randomly distributed choroidal mostly atrophic yellow-white foci with pigment spots that can sometimes become adjacent to each other and form a ribbon of pearls (Fig. 14.5a). These lesions involve the posterior pole as well as the periphery or both. In the active phases of disease new lesions are not always visible and can be very discreet on FA, whereas ICGA is the most sensitive method for detecting new lesions [28, 51]. One particular feature of multifocal choroiditis is the high proportion of neovascu-lar membranes complicating the disease.

Fig. 14.5 a-c. Multifocal choroiditis (MFC). Numerous depigmented foci in both the right and left fundus (a) in a patient presenting a second episode of visual field loss. ICGA shows an extensive area of patchy and geographically confluent choriocapillaris non-perfusion (b), whereas fluorescein angiography is quasi normal except for patchy areas of late hyperflu-orescence (c)

Fig. 14.5 a-c. Multifocal choroiditis (MFC). Numerous depigmented foci in both the right and left fundus (a) in a patient presenting a second episode of visual field loss. ICGA shows an extensive area of patchy and geographically confluent choriocapillaris non-perfusion (b), whereas fluorescein angiography is quasi normal except for patchy areas of late hyperflu-orescence (c)

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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