Purpose
Serpiginous choroiditis (SC) is a rare, progressive posterior uveitis characterized by a peripapillary choroiditis that recurs at the margin of previous retinal pigment epithelium (RPE) atrophy. The purpose of this study was to describe the clinical and imaging features of patients with SC.
Methods
Medical records and diagnostic imaging including fundus photography (FP), fluorescein angiography (FA), indocyanine green angiography (ICG), fundus autofluorescence (FAF), and spectral domain optical coherence tomography (SD-OCT) of patients diagnosed with SC at a tertiary-center, university-based practice were reviewed.
Results
Seven eyes of four patients with SC were identified with a mean age at diagnosis of 56 years (range 41 to 75 years) and mean follow up of 42 months (range 3 to 74 months). The mean initial and final Snellen visual acuity (VA) for fovea-involving SC was 20/125-4 and 20/160 (range 20/80-1 to counting fingers at 2 feet). The mean initial and final Snellen VA for fovea-sparing SC was 20/20-3 and 20/30. FAF clearly delineated SC activity; hyperautofluorescence indicated RPE damage and SC activity whereas hypoautofluorescence indicated RPE loss and SC inactivity (Figure 1B). SD-OCT in active lesions showed increased RPE hyperreflectivity, ellipsoid layer attenuation, and subtle loss of choroidal vascular details relative to uninvolved areas (Figure 2A). FA exhibited hypofluorescence of the lesion with late leakage from the choriocapillaris at the active border and variable late staining of inactive areas. ICG showed hypocyanescent patches indicating absent choroidal flow or underlying choroidal inflammation with variable stippled hypercyanescence at the active border. SD-OCT of inactive lesions showed sparing of the general architecture of the retinal layers save for loss of the ellipsoid layer, loss of the external limiting membrane, loss of the RPE leading to increased signal transduction, and thinned choroid with loss of vascular details in the involved areas (Figure 2B). Correlation with ICG demonstrated lesion hypocyanescence indicating absent choroidal flow.
Conclusions
SD-OCT, FA, and ICG imaging characteristics indicate that SC is an inner and outer choroidal process leading to choriocapillaris atrophy and secondary overlying RPE and retinal changes. FAF clearly highlighted disease activity and resolution.
Keywords: 550 imaging/image analysis: clinical •
746 uveitis-clinical/animal model •
552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)