PERIVASCULAR MULTIFOCAL CHOROIDITIS WITH PANUVEITIS: Clinical and Multimodal Imaging Features

Purpose: To describe the long-term clinical and imaging features of the perivascular phenotype of multifocal choroiditis with panuveitis (PV-MFCPU). Methods: Retrospective observational case series of eight patients (14 eyes) diagnosed with PV-MFCPU at tertiary uveitis referral centers. Clinical data and multimodal imaging—including ultra-widefield color fundus photography (CFP), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography, optical coherence tomography (OCT) and OCT angiography—were reviewed at all available visits, with analyses focused on baseline and final follow-up visits. A comprehensive systemic work-up was performed to exclude infectious, autoimmune, and neoplastic etiologies. Results: Median age at presentation was 27 years (IQR, 17-51), with a median follow-up of 5.4 years (IQR, 3-10.1). Disease was bilateral in 6/8 patients (75%). Lesions demonstrated a reproducible perivascular distribution along retinal arteries and/or veins, frequently extending into the mid- and far-periphery. On CFP and FAF, lesions appeared as pigmented, hypoautofluorescent spots evolving into sharply demarcated atrophic scars. FA showed late hyperfluorescent staining without leakage. OCT revealed outer retinal and retinal pigment epithelium disruption, subretinal hyperreflective material (SHRM), vertical hyperreflective column bridging the SHRM and overlying retinal vessels, and progression to atrophy. Infectious and inflammatory evaluations were negative in all cases. Mild, transient anterior segment or vitreous inflammation was observed in a minority of eyes. Median BCVA remained stable at 20/25 (IQR, 20/32-20/20). Choroidal neovascularization occurred in 3/14 eyes (21%) and responded to anti-VEGF therapy. Conclusion: PV-MFCPU represents a perivascular topographic phenotype within the MFCPU spectrum. Recognition of PV-MFCPU may improve differentiation from vasculitic and inflammatory chorioretinal mimickers.