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A case of atypical serpiginous choroiditis: Ampiginous choroiditis

Poster Details

First Author: R.Uceda Torres SPAIN

Co Author(s):    B. Dominguez Garcia   A. Gomez Escobar                          

Abstract Details



Purpose:

Ampiginous coroiditis is a rarely, intermediary form between acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous coroiditis. The propose of these case report is to present the distinguishing features of APMPPE, serpiginous coroiditis and ampiginous coroiditis.

Setting:

Case report

Methods:

A 43 year-old woman, who is in good general health, was referred to us with progressive painful visual blurring (paracentral scotoma) after an flu-like episode. Best-corrected visual acuity was 20/25 for the right and 20/63 for the left eye (amblyopic eye). Fundus examination showed scattered chorioretinal lesions with pseudopodial extensions and multiple yellow-greyish irregularly bordered lesions. Fluorescein angiography demonstrated these lesions to be early hypofluorescent with late hyperfluorescent staining of the borders. An OCT scan of the macula showed focal disruptions of the inner/outer segment line and subfoveal choroidal thinning. She was started with oral prednisone (30 mg/day) and Metotrexate 7.5 mg/week.

Results:

Infectious serologic and autoimmune markers, full blood count, liver function, chest X-ray and tuberculin skin test were unremarkable. After 5 months, only with Metotrexate 12.5 mg/week, visual acuity has remained stable and no appearance of new lesions or enlargement of the known lesions has occurred. Hypoautofluorescence at the edges of the lesions indicates no progression of the lesions. The multifocal pattern of the lesions and the angiographic features led to the diagnosis of ampiginous choroiditis.

Conclusions:

Ampiginous choroiditis is a primary inflammatory choriocapillaropathy with characteristics of both APMPPE and serpiginous choroiditis. Multifocal, peripheral and asymmetric lesions reminiscent of APMPPE, however, evolved to outer retinal atrophy with angiographic characteristics reminiscent of serpiginous choroiditis. Ampiginous choroiditis is a disease with multiple relapses, which can be effectively controlled with a combination of immunosuppressive therapy, and a good visual acuity can be maintained on long-term follow-up.

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