Purchase this article with an account.
Ester Carreno, Alejandro Portero, Jose M. Herreras, Margarita Calonge, C Stephen Foster; Distinctive Clinical Features of Idiopathic vs Infectious Serpiginous Choroidopathy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1202.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Serpiginous choroiditis (SC) is a progressive inflammatory disease. It usually is severe enough as to lead to visual impairment. Its treatment usually consists on combinations of immunomodulatory drugs. The sparing of juxtapapillary area, the multifocal pattern, and the presence of intraocular inflammation are suggested as atypical features, termed as serpiginous-like choroiditis (SLC) and have been described associated with tuberculosis (TB) and toxoplasmosis. To date, no other infectious etiologies have been reported in association with SLC and there is only one study comparing the clinical features of TB-associated SLC and SC. The aim of this study is to describe SLC due to infections other than TB and compare the clinical features of these SLC cases with SC.
Multi-center, non-interventional case series. Comparative analysis of clinical features of SC and SLC. The variables analyzed were: age, gender, laterality, final visual acuity (VA), anterior chamber and/or vitreous cells, involvement of juxtapapillary area, multifocal pattern, involvement of the posterior pole, and presence of choroidal neovascularization (CNV). Statistical significance for intergroup differences was assessed by Mann-Whitney U and Fisher’s exact tests.
Twenty-nine patients (54 eyes) were included: 24 patients (45 eyes) had SC and 5 patients (9 eyes) had SLC: 2 cases TB, 1 borreliosis, 1 tularemia, and 1 bartonellosis. Mean age at diagnosis was 50 and 46 years for the SC and SLC groups, respectively. There were 54% males in the SC group, versus 80% in the SCL group. The disease was bilateral in 87.5% of patients in the SC group and in 80% in the SLC group. The mean final VA was 20/40 in SC patients and 20/25 in SLC cases. The juxtapapillary area was involved in 91% of the eyes in the SC group and in none of eyes in the SLC group (p<0.05). Multifocal pattern, posterior pole involvement, intraocular cellular reaction and CNV were similar in both groups.
We confirm SLC associated with infections different from TB or toxoplasmosis. These cases never involved the juxtapapillary area. In cases of SLC where the peripapillary area is spared, an infectious etiology has to be strongly suspected. Differentiation between SC and SLC is therefore crucial due to the devastating consequences of an immunomodulatory treatment for an infectious disease.
This PDF is available to Subscribers Only