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Combined corticosteroid and immunosuppressive therapy in treatment of serpiginous choroiditis

Poster Details

First Author: D.Kovacevic Pavicevic SERBIA

Co Author(s):    A. Radosavljevic   A. Ilic   N. Kosanovic Jakovic   I. Kovacevic   Z. Abazi      0   0 0   0 0   0 0   0 0

Abstract Details



Purpose:

Serpiginous choroiditis is an idiopathic, progressive recurrent primary inflammatory choriocapillaropathy that leads to non-reversible destruction of the chorioretina and has severe course of with high risk of blindness (38% of patients has final visual acuity 0.1 or less). It is also called geographical or helicoid choroidopathy. Before retaining the diagnosis of serpiginous choroiditis, infectious chorioretinitis, in particular tuberculosis, syphilis and toxoplasmosis, must be excluded. The purpose of this paper is to present a case of sepiginous choroiditis and treatment challenges for this disease.

Setting:

Uveitis department of Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade, Serbia.

Methods:

Case report of the patient treated at the Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade. Patient underwent complete ophthalmological investigation including visual acuity (VA) assessment, applanation tonometry, slit lamp and fundus examination, fluorescein angiography (FA) and optical coherence tomography (OCT). Systemic investigation included: biochemical analyses, blood count, SE rate, CRP, immunological investigation, HLA typization, serological analyses for HSV, VZV, CMV, Toxoplasma gondii, Borrelia burgdorferi, Rö of the thorax as well as pulmological investigation.

Results:

A 55-year-old female was examined in November 2010, due to the sudden loss of vision on the right eye. Patient was myopic and had a history of low vision on the left eye for 20 years. Best corrected VA of the right eye (RE) was 0.1 and left (LE) 0.5/60. Intraocular pressure was 14 mmHg. Except bilateral cortical cataract, anterior segment had normal findings. On both eyes, juxtapapillar, helicoidal yellowish atrophic chorioretinal lesions were observed, as well as mild vitritis. Also, in the right eye, retinal oedema and infiltration extending from the optic nerve head in the macula was observed and in the left eye, large interpapillomacular scar. OCT showed choroidal neovascular membrane in the RE and macular scar in the LE. After exclusion of potential infective causes, in the treatment were introduced per oral Cyclosporine A and Prednisone as well as subconjunctival corticosteroid injections. Two week later, BCVA of RE improved to 0.8 and LE 0.5/60. After seven months of treatment BCVA of the RE was 1.0. During the treatment blood levels of Cyclosporine A, as well as liver and renal functions were monitored and were within limits.

Conclusions:

Treatment with Cyclosporine A and Prednisone was efficacious in preventing the progression of serpiginous choroiditis and preservation of visual function. The patients’ treatment and follow up is ongoing.

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