When disease mechanism is more important than disease phenotype: the example of multifocal choroiditis of the choriocapillaritis type

Inflammatory choriocapillaropathies (ICCP) is the name given to a group of diseases affecting the choroicapillaris. Primary inflammation of the choriocapillaris was suspected long before indocyanine green angiography (ICGA) became routinely available. In fact, fluorescein angiography (FA) is not tool capable to detect choroidal ischemia and does not give imaging access to the rest of the choroid. One of the main characteristics described in such group of diseases is represented by their eclectic attitude. The reason why the disease behaviours are so different from one condition to the other is still unknown. Among this group it is recognized a sub-group of diseases known as multifocal choroiditis. When seen by the clinician most of the cases already show chorioretinal scars, as if preceding silent episodes occur before the disease becomes symptomatic at the time of a recurrence. Multifocal choroiditis occurs in the same age groups as other ICCPs, namely in young to middle aged adults with women being predominantly affected. Lesions tend to leave scars and are not spontaneously reversible but seem to respond corticosteroid therapy. Subretinal neovascular membranes occur in one third of patients.