Intravitreal Dexamethasone Implant in Punctate Inner Choroidopathy: Clinical Indications and Outcomes in a Real-World Case Series

The aim of this study is to characterize the clinical indications, treatment patterns, and outcomes associated with intravitreal dexamethasone implant (DEX implant) in eyes with punctate inner choroidopathy (PIC). This retrospective observational case series included eyes with PIC treated with at least one DEX implant. Eyes were categorized according to the indication for treatment as (1) bridging therapy while initiating systemic immunomodulatory therapy (IMT), (2) adjunctive treatment for recurrent inflammatory activity despite ongoing IMT, or (3) local therapy in patients not receiving systemic IMT. Main outcome measures included best-corrected visual acuity (BCVA), inflammatory control, inflammatory recurrence, retreatment requirements, and safety. Twenty-five eyes from 22 patients were included. Mean age at index injection was 56.5 ± 11.1 years, and 18/22 patients (82%) were female. DEX implant was used as bridging therapy in 5 eyes (20%), adjunctive therapy during ongoing IMT in 6 eyes (24%), and local therapy without IMT in 14 eyes (56%). A total of 33 DEX implants were administered during follow-up. Complete resolution of inflammatory activity was achieved in all eyes within 6 months of the first DEX implant. Mean BCVA remained stable, from 0.33 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.34 logMAR at month 6. Inflammatory recurrence occurred in 7/25 eyes (28%) after a mean of 6.0 ± 3.5 months, with no recurrences observed among eyes receiving DEX implant during ongoing IMT. Intraocular pressure elevation occurred in 12/25 eyes (48%) and was successfully controlled with topical therapy. Other ocular adverse events were infrequent and included retinal detachment, peripheral retinal hole, hypotony, and posterior vitreous detachment, each occurring once in a different eye (4% each). Intravitreal DEX implant provides effective short-term control of inflammatory activity in PIC and serves multiple complementary roles in clinical practice, including bridging during IMT initiation, adjunctive treatment for breakthrough inflammation, and stand-alone local therapy in selected patients. The absence of recurrences among eyes receiving concomitant IMT and the higher recurrence rate in those cases managed without systemic immunomodulation suggest that DEX implant is most effectively integrated into a broader long-term immunomodulatory strategy for patients with relapsing disease.