Choroiditis, serpiginous

Choroiditis, Serpiginous

Serpiginous choroiditis, also known as geographic choroiditis or helicoid choroidopathy, is a rare, chronic, progressive inflammatory disease affecting the choroid, a vascular layer of the eye. This condition is characterized by serpentine or snake-like lesions that spread across the retina and choroid, leading to vision loss if untreated.

Pathophysiology

Serpiginous choroiditis primarily affects the choroid, which is the layer of blood vessels and connective tissue between the sclera and the retina. The inflammation in serpiginous choroiditis is thought to be immune-mediated, although the exact etiology remains unclear. The disease typically presents with bilateral involvement, though it may initially appear unilateral.

The lesions in serpiginous choroiditis begin at the optic disc and extend outward in a serpentine pattern. These lesions can cause damage to the overlying retinal pigment epithelium and photoreceptors, leading to scotomas and vision loss.

Clinical Presentation

Patients with serpiginous choroiditis often present with:

• Blurred vision
• Central or paracentral scotomas
• Metamorphopsia (distorted vision)
• Photopsia (flashes of light)

The disease typically affects adults between the ages of 30 and 60 and has no gender predilection.

Diagnosis

Diagnosis of serpiginous choroiditis is primarily clinical, supported by imaging studies such as:

• Fluorescein angiography: Shows early hypofluorescence and late hyperfluorescence of the lesions.
• Indocyanine green angiography: Useful for visualizing choroidal vasculature and lesions.
• Optical coherence tomography (OCT): Reveals disruption of the retinal layers and choroidal involvement.

Treatment

Treatment of serpiginous choroiditis aims to control inflammation and prevent progression. Common treatment options include:

• Corticosteroids: Systemic or periocular injections to reduce inflammation.
• Immunosuppressive agents: Such as azathioprine, cyclosporine, or mycophenolate mofetil.
• Biologic agents: Such as infliximab or adalimumab in refractory cases.

Prognosis

The prognosis of serpiginous choroiditis varies. Early diagnosis and treatment are crucial to prevent significant vision loss. The disease is chronic and may have periods of remission and exacerbation.

Also see

• Choroiditis
• Uveitis
• Retinal vasculitis
• Macular degeneration