Serpiginous Choroiditis

Thirty two-year-old hispanic male presented with a visual acuity of counting finger. The patient had similar episode in the left eye in the previous year. Note an active lesion with a relatively sharp border involving the fovea of the right eye (white arrow). 

  • Rare, chronic, bilateral inflammatory disorder
  • Recurrences are common
  • Onset is usually between ages 30 and 70 years

Clinical features:

  • Symptoms:
    • Painless blurring of vision with central or paracentral scotoma
    • Metamorphopsia due to macular involvement
  • Signs:
    • Acute onset lesion: gray-yellowish discoloration of the RPE with a pseudopodial configuration extending in a centrifugal manner from the optic disc
    • Acute lesions normally last in several weeks, followed with development of chorioretinal atrophy and RPE migration along the large choroidal vasculature
    • Previous inflammation is evidence with areas of atrophic RPE, choriocapillaris and pigment clumpings
    • New lesions are often contiguous with the chronic lesions
    • Can be complicated with choroidal neovascularization

Fluorescein angiogram demonstrates:

  • Acute lesions: hypofluorescence in the early phases and hyperfluorescence with leakage or staining of the lesion evolving centrally in the mid to late phases
  • Mottled hyperfluorescence due to pigment clumping in chronic lesions
  • Electrophysiologic studies are normal.
  • Occasional cases have been associated with the administration of anti-tuberculosis drugs.

Management:

  • Self assessment with Amsler grid test
  • Triple immunosuppression with; systemic corticosteroid, acyclovir and cyclosporin in vision threatening cases, such as macular or papillomacular involvement.
  • Laser photocoagulation and submacular surgery in cases complicated with choroidal neovascularization.