Arvind Babu1, Narayanan Balakrishnan2, Uma Maheshwari3, Praveena V.4, Dharssana Periyathambi5
BACKGROUND
Serpiginous choroiditis (SC) is an intraocular inflammatory disorder displaying a
geographic pattern of choroiditis, extending from the juxtapapillary choroid and
intermittently spreading centrifugally. It involves the overlying retinal pigment
epithelium (RPE), the outer retina including the choriocapillaries and the
choroid.1,2,3 Infectious diseases like tuberculous (TB) uveitis, herpes simplex virus
(HSV) uveitis whose fundus changes mimic SC are termed as serpiginous-like
choroidopathy (SLC). On slit lamp examination, anterior segment usually appears
quiet, non-granulomatous anterior uveitis with mild vitritis and / or fine pigmented
cells within the vitreous can be seen. The pattern of fundus involvement varies
between the two groups. Fundus fluorescein angiography and indocyanine green
angiography (FFA and ICG) are important modalities of investigation that help in
differentiating the pattern of involvement and confirming clinical findings. The
duration of follow up, reactivation of lesions and complications vary. Hence, it is
important to differentiate between SC and SLC for proper diagnosis and
appropriate management. The aim of this study is to highlight important features
of serpiginous choroiditis and serpiginous like choroidopathy that will aid in the
correct diagnosis of these two entities.
METHODS
This is a retrospective study of 40 patients. Following variables were analysed -
age, gender, laterality, visual acuity, and intraocular inflammation through slit
lamp examination, pattern of involvement, choroidal-neovascularization,
reactivation, clinical investigations and diagnosis.
RESULTS
32 patients had serpiginous choroiditis (SC) and eight patients had serpiginous like
choroiditis (SLC). Mean age was 50 and 51 years (SC and SLC respectively). Males
were predominantly affected (65.5 % in serpiginous choroiditis and 62.5 % in
serpiginous like choroiditis). Bilaterality was 80 % in SC-group and 46 % in the
SLC-group. Vitreous haze was lesser than or equal to 1 + in SC group. The
juxtapapillary-area was involved in 90 % in SC eyes and 0 % in SLC-group.
Midperiphery of fundus was involved in 54 % of SLC-group. Reactivation is more
common in SLC group than in SC group in a follow up period of one year.
Choroidal-neovascularisation was found in two patients only in SLC-group.
CONCLUSIONS
In cases where vitreous haze is greater than 1 + with unilateral involvement and
disease free peripapillary area is present, an infectious aetiology has to be strongly
suspected, as an immunomodulatory therapy could have severe consequences.
