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Anthony Hall, Jason Toniolo, Jo Sims, Samantha Fraser-Bell, Jane Khan, Christine Younan, Brian Kent-Smith, Stephanie Young, Eldho Paul, Lyndell Lim, ; A retrospective analysis of the natural history and management of serpiginous choroidopathy (SC) in Australia and New Zealand. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5385.
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To examine the prevalence of serpiginous choroidopathy (SC) in a predominantly Caucasian community, to examine associations between SC and other systemic diseases, and to determine the effect of immunosuppression on the long-term relapse rate of SC.
Retrospective cohort study of SC patients using the Australian and New Zealand Ophthalmic Surveillance Unit. Data collected included patient demographics, clinical features, associated systemic diseases, initial and maintenance treatments administered and dates of relapse. Three maintenance treatment groups were identified: No maintenance treatment, maintenance treatment with prednisolone monotherapy and maintenance treatment with combination prednisolone and immunosuppressant therapy. Negative binomial regression was used to calculate incidence rate ratios for patient relapse depending on which maintenance treatment category the patient fell into at the time of relapse.
18 patients (9 male, 9 female, mean age 48 yrs at baseline) were identified. One patient was seen only once. For the remaining 17 patients, median follow up was 69 months (5.8 years, range 0.4-29.7 years). The prevalence of SC in Australia and NZ was between 1 in 702,000 and 1 in 1.5 million people. Five cases (28%) had a positive QuantiFERON and 1 of these had pulmonary tuberculosis. A total of 32 relapses were observed (1 per 4.8 patient years of followup); 14 whilst receiving no maintenance treatment, 11 on maintenance prednisolone and 7 on maintenance therapy with combined immunosuppressive therapy. Compared to the no treatment group, the incidence rate ratio for relapse on prednisolone monotherapy and combination therapy were 1.29 and 2.92 respectively (95% CI: 0.40-4.14 and 0.96-8.88).
SC is uncommon in Australia and New Zealand. Tuberculosis is associated with a significant minority of SC cases in Australian and New Zealand. There is a significant subpopulation of patients with SC who have a benign course. Whilst the confidence intervals indicate that the difference in relapse incidence rate ratios are not significant, these treatment results do not suggest a reduced incidence of relapses for patients receiving combination prednisolone and immunosuppressant therapy.
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