Long -term Outcomes and Management of Patients With Serpiginous Choroiditis

Abstract

Purpose:: To describe the long-term outcomes and treatment management in 20 Italian patients with serpiginous choroiditis.

Methods:: A retrospective study of patients with funduscopic lesions consistent with diagnosis of serpiginous choroiditis, seen at the Ocular Immunology Service, University Hospital San Raffaele, Milan,was performed. The main outcome parameters evaluated were: demographic characteristics, duration of follow up, visual acuities, ocular complications, disease control, treatment management.

Results:: Charts of twenty patients with serpiginous choroiditis (8 female, 12 male) with a median age of 60.5 years (range: 43-78) were reviewed. All patients presented with bilateral disease. Patients were followed for a median follow up time of 44.2 months (range 7-120). All patients were treated with systemic corticosteroids. Systemic immunosuppressants were given in addition to corticosteroids: 7 patients received only one immunosuppressant and 13 patients received multiple chemotherapeutic agents.The median long-term duration of treatment was 32 months (range: 26-45). Choroidal neovascularization occurred in 3 patients. At the end of our follow up 11 patients are in remission without treatment (long-term remission ranged from 17 to 86 months); 5 patients are in remission on systemic immunosuppressants and 4 patients continue to have recurrences of inflammation despite systemic aggressive treatment. Final visual acuity was ≤ 20/200 in 14 eyes (12 patients).

Conclusions:: Systemic immunosuppressive treatment seems to reduce the rate of inflammatory recurrences and to favourably alter the long-term prognosis of patients with serpiginous choroiditis. Nevertheless, there is a subgroup of patients who fail to achieve control of inflammation despite aggressive multiple immunosuppressive treatment.

Keywords: uveitis-clinical/animal model • autoimmune disease • choroid