Punctate inner choroidopathy (PIC) is an uncommon idiopathic inflammatory condition characterized by multifocal chorioretinopathy that primarily affects young adults, with a predilection for myopic females. Clinically, it manifests as small, yellowish-white lesions in the inner choroid and outer retina, often associated with inflammatory changes. Accurate diagnosis remains a challenge due to its resemblance to other posterior uveitic entities, necessitating an astute clinical eye and advanced imaging techniques for differentiation. Multimodal imaging plays a crucial role by offering valuable insights, as it enables the visualization of various abnormalities related to uveitis. The pathogenesis of PIC is still a subject of debate, with a complex interplay of genetic, immunological, and environmental factors proposed. Managing PIC presents multiple challenges for clinicians. Firstly, variable disease severity within and among patients requires diverse treatments, from observation to aggressive immunosuppression and/or anti-VEGF therapy. Secondly, treatment must distinguish between primary causes of vision loss. New or worsening PIC lesions suggest active inflammation, while new neovascular membranes may indicate secondary neovascular processes. Thirdly, deciding on maintenance therapy is complex, balancing PIC prognosis variability against immunosuppression risks. Some patients have long periods of inactivity and remission, while others face sudden, vision-threatening episodes during quiescent phases. Through a systematic review of the literature, this paper sheds light on the current understanding of PIC, its challenges, and the prospects for future research. By synthesizing existing knowledge, it aims to aid clinicians in accurate diagnosis and guide treatment decisions for improved visual outcomes in individuals affected by PIC.

中文翻译：

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点状内部脉络膜病变：当前诊断和治疗方法的回顾


点状内部脉络膜病变 (PIC) 是一种罕见的特发性炎症性疾病，其特征是多灶性脉络膜视网膜病变，主要影响年轻人，好发于近视女性。临床上表现为内脉络膜和外视网膜的小黄白色病变，常伴有炎症改变。由于其与其他后葡萄膜炎实体相似，准确诊断仍然是一个挑战，需要敏锐的临床眼睛和先进的成像技术来区分。多模态成像通过提供有价值的见解而发挥着至关重要的作用，因为它能够可视化与葡萄膜炎相关的各种异常。 PIC 的发病机制仍然是一个有争议的话题，遗传、免疫和环境因素之间存在复杂的相互作用。管理 PIC 给临床医生带来了多重挑战。首先，患者内部和患者之间不同的疾病严重程度需要不同的治疗，从观察到积极的免疫抑制和/或抗 VEGF 治疗。其次，治疗必须区分视力丧失的主要原因。新的或恶化的 PIC 病变提示活动性炎症，而新的新生血管膜可能表明继发性新生血管过程。第三，维持治疗的决定很复杂，需要平衡 PIC 预后变异性和免疫抑制风险。一些患者有长时间不活动和缓解期，而另一些患者在静止期面临突然的、威胁视力的发作。通过对文献的系统回顾，本文阐明了目前对 PIC 的理解、其挑战以及未来研究的前景。 通过综合现有知识，它旨在帮助临床医生准确诊断并指导治疗决策，以改善 PIC 患者的视力结果。