Clinical profile and progress of serpiginous choroiditis_Chinese Journal of Ocular Fundus Diseases

Authors：

ZouHong ,  MiaoWanhong

Department of Ophthalmology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China;

Corresponding author：

MiaoWanhong, Email: miaowanh@126.com

Keywords：

Choroiditis/diagnosis; Choroiditis/drug therapy; Choroiditis/etiology; Review

DOI：

10.3760/cma.j.issn.1005-1015.2017.01.032

Video：

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Serpiginous choroiditis (SC) is infrequent, chronic and posterior uveitis displaying a geographic pattern of choroiditis easy to recur. Studies reveal that the active lesions of inflammatory processes are mainly localized to the choriocapillaris and retinal pigment epithelium cells. SC may manifest with variable features, although a creeping pattern of choroiditis, extending from the juxtapapillary area, with grayish yellow discoloration. Fundus fluorescein angiography, indocyanine green angiography, fundus auto-fluorescence and optical coherence tomography are helpful to diagnose atypical SC. In addition, these image examinations can evaluate the activity and progression of lesion, and detect any complication that might occur. SC is mainly distinguished from multifocal SC related with tuberculosis or virus and etc. Pathogenesis is unclear, an organ-specific autoimmune inflammation or infection seems likely to be the underlying process. It is mainly using glucocorticoid with immunosuppressant therapy at present. Timely and effectively control inflammation can effectively prevent vision loss, choroidal neovascularization and choroidal scar in SC patients.

Citation： ZouHong, MiaoWanhong. Clinical profile and progress of serpiginous choroiditis. Chinese Journal of Ocular Fundus Diseases, 2017, 33(1): 100-103. doi: 10.3760/cma.j.issn.1005-1015.2017.01.032 Copy

1.	Pivetti-Pezzi P, Accorinti M, La Cava M, et al. Endogenous uveitis: an analysis of 1,417 cases[J]. Ophthalmologica, 1996, 210(4): 234-238.
2.	Broekhuyse RM, van Herck M, Pinckers AJ, et al. Immune responsiveness to retinal S-antigen andopsin in serpiginous choroiditis and other retinal diseases[J]. Doc Ophthalmol, 1988, 9(1): 83-93.
3.	Abrez H, Biswas J, Sudharshan S. Clinical profile, treatment, and visual outcome of serpiginous choroiditis[J]. Ocul Immunol Inflamm, 2007, 15(4): 325-335. DOI: 10.1080/09273940701375162.
4.	Karagiannis DA, Sampat FV, Dowler J. Serpiginous choroidopathy with bilateral foveal sparing and good visual acuity after 18 years of disease[J]. Retina, 2007, 27(7): 989-990. DOI:10.1097/IAE. 0b013e3180592b8e.
5.	Priya K, Madhavan HN, Reiser BJ, et al. Association of herpesviruses in the aqueous humor of patients with serpiginous choroiditis: a polymerase chain reaction-based study[J]. Ocul Immunol Inflamm, 2002, 10(4): 247-261. DOI:10.1076/ocii. 10.4.253.15585.
6.	Nazari KH, Rao NA. Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis[J].Surv Ophthalmol, 2013, 58(3): 203-232.DOI: 10.1016/j.survophthal.2012.08.008.
7.	Vasconcelos-Santos DV, Rao PK, Davies JB, et al. Clinical features of tuberculous serpiginous like choroiditis in contrast to classic serpiginous choroiditis[J]. Arch Ophthalmol, 2010, 128(7): 84784-84788. DOI: 10.1001/archophthalmol.2010.116.
8.	Jyotirmay B, Jafferji SS, Sudharshan S, et al. Clinical profile, treatment, and visual outcome of serpiginous choroiditis[J]. Ocul Immunol Inflamm, 2010, 18(1): 46-51. DOI: 10.3109/09273940 903402637.
9.	Saurabh K, Panigrahi PK, Kumar A, et al. Profile of serpiginous choroiditis in a tertiary eye care centre in eastern India[J]. Indian J Ophthalmol, 2013, 61(11): 649-652. DOI: 10.4103/0301-4738.119409.
10.	Sahu DK, Rawoof A, Sujatha B. Macular serpiginous choroiditis[J]. Indian J Ophthalmol, 2002, 50(3): 189-196.
11.	Altan-Yaycioglu R, Akova YA, Akca S, et al. Inflammation of the posterior uvea: findings on fundus fluorescein and indocyanine green angiography[J]. Ocul Immunol Inflamm, 2006, 14(3): 171-179.
12.	Cohen SY, Dubois L, Quentel G, et al. Is indocyanine green angiography still relevant?[J] Retina, 2011, 31(2): 209-221. DOI: 10.1097/IAE.0b013e31820a69db.
13.	Cardillo PF, Grosso A, Savini E. Fundus autofluorescence in serpiginous choroiditis[J].Graefe’s Arch Clin Exp Ophthalmol, 2009, 247(2): 179-185. DOI: 10.1007/s00417-008-0951-z.
14.	Gallagher MJ, Yilmaz T, Cervantes-Castaneda RA, et al. The characteristic features of optical coherence tomography in posterior uveitis[J]. Br J Ophthalmol, 2007, 91(12): 1680-1685. DOI: 10.1136/bjo.2007.124099.
15.	Balaskas K, Ur Rehman S, D'Souza Y. Long-term ranibizumab treatment for choroidal neovascularization secondary to serpiginouschoroiditis[J]. Can J Ophthalmol, 2012, 47(5): 15-17. DOI: 10.1016/j.jcjo.2012.03.032.
16.	Rifkin LM, Munk MR, Baddar D, et al. A new OCT finding in tuberculous serpiginous-like choroidopathy[J]. Ocul Immunol Inflamm, 2015, 23(1): 53-58. DOI: 10.3109/09273948.2014.964421.
17.	Van Velthoven ME, Ongkosuwito JV, Verbraak FD, et al. Combined en-face optical coherence tomography and confocal ophthalmoscopy findings in active multifocal and serpiginous chorioretinitis[J]. Am J Ophthalmol, 2006, 141(5): 972-975. DOI: 10.1016/j.ajo.2005.12.050.
18.	Carreño E, Fernandez-Sanz G, Sim DA, et al. Multimodal imaging of macular serpiginous choroidopathy from acute presentation to quiescence[J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(2): 266-270. DOI: 10.3928/23258160-20150213-04.
19.	Pilotto E, Vujosevic S, Grgic VA, et al. Retinal function in patients with serpiginous choroiditis: a microperimetry study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2010, 248(9): 1331-1337. DOI:10.1007/ s00417-010-1405-y.
20.	Shetty SB, Biswas J, Murali S. Real-time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid choroiditis caused by mycobacterium tuberculosis - a case report[J]. J Ophthalmic Inflamm Infect, 2014, 4(1): 29. DOI: 10.1186/s12348-014-0029-5.
21.	Rodman J, Pizzimenti J. Serpiginous choroiditis in a herpes-positive patient[J]. Optom Vis Sci, 2011, 88(6): 776-780. DOI: 10.1097/OPX.0b013e3182139357.
22.	Mahendradas P, Kamath G, Mahalakshmi B, et al. Serpiginous choroiditis-like picture due to ocular toxoplasmosis[J]. Ocul Immunol Inflamm, 2007, 15(2): 127-130.
23.	Mahendradas P, Kamath G, Mahalakshmi B, et al. Serpiginous choroiditis-like picture due to ocular toxoplasmosis[J]. Ocul Immunol Inflamm, 2007, 15(2): 127-130. DOI: 10.1080/0927 3940701244202.
24.	Bodaghi B, LeHoang P. Ocular tuberculosis[J]. Curr Opinion Ophthalmol, 2000, 11(6): 443-448. DOI: 10.1097/00055735-200012000-00010.
25.	Gupta A, Bansal R, Gupta V, et al. Ocular signs predictive of tubercular uveitis[J]. Am J Ophthalmol, 2010, 149(4): 562-570. DOI: 10.1016/j.ajo.2009.11.020.
26.	Nayak S, Basu S, Singh MK. Presumed tubercular retinal vasculitis with serpiginous-like choroiditis in the other eye[J]. Ocul Immunol Inflamm, 2011, 19(5): 361-362. DOI: 10.3109/09273948. 2011.590917.
27.	Vasconcelos-Santos DV, Rao PK, Davies JB, et al. Clinical features of tuberculous serpiginouslike choroiditis in contrast to classic serpiginous choroiditis[J]. Arch Ophthalmol, 2010, 128(7): 853-858. DOI: 10.1001/archophthalmol.2010.116.
28.	Toniolo J, Hall AJ, Sims J, et al. Retrospective analysis of the natural history and management of serpiginous choroiditis in Australia and New Zealand[J]. Clin Exp Ophthalmol, 2014, 42(7): 656-664. DOI: 10.1111/ceo.12283.
29.	Jabs DA, Rosenbaum JT, Foster CS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel[J]. Am J Ophthalmol, 2000, 130(4): 492-513. DOI:10.1016/S0002-9394 (00)00659-0.
30.	Goldstein DA, Fontanilla FA, Kaul S, et al. Long-term follow-up of patients treated with shorttermhigh-dose chlorambucil for sight-threatening ocular inflammation[J]. Ophthalmology, 2002, 109(2): 370-377.
31.	Akpek EK, Jabs DA, Tessler HH, et al. Successful treatment of serpiginous choroiditis withalkylating agents[J]. Ophthalmology, 2002, 109(8): 1506-1513.
32.	Venkatesh P, Gogia V, Gupta S, et al. Pulse cyclophosphamide therapy in the management of patients with macular serpiginous choroidopathy[J]. Indian J Ophthalmol, 2015, 63(4): 318-322. DOI: 10.4103/0301-4738.158070.
33.	Sobaci G, Bayraktar Z, Bayer A. Interferon alpha-2a treatment for serpiginous choroiditis[J]. Ocul Immunol Inflamm, 2005, 13(1): 59-66. DOI: 10.1080/09273940490518865.
34.	Seve P, Mennesson E, Grange JD, et al. Infliximab in serpiginous choroiditis[J]. Acta Ophthalmol, 2010, 88(8): 342-343. DOI: 10.1111/j.1755-3768.2009.01738.x.
35.	Chinchurreta CA, Requena Jiménez JM, Lorenzo Soto M, et al. Effectiveness of adalimumab for refractory serpiginous-choroiditis[J]. Ocul Immunol Inflamm, 2014, 22(5): 405-408. DOI: 10.3109/09273948.2013.859276.
36.	Wadhwa N, Garg SP, Mehrotra A. Prospective evaluation of intravitreal triamcinolone acetonidein serpiginous choroiditis[J]. Ophthalmologica, 2010, 224(3): 183-187. DOI: 10.1159/000252981.
37.	Seth RK, Gaudio PA. Treatment of serpiginous choroiditis with intravitreous fluocinolone acetonide implant[J]. Ocul Immunol Inflamm, 2008, 16(3): 103-105. DOI: 10.1080/09273940802023778.
38.	Navajas EV, Costa RA, Farah ME, et al. Indocyanine green-mediated photothrombosis combinedwith intravitreal triamcinolone for the treatment of choroidal neovascularization in serpiginous choroiditis[J]. Eye, 2003, 17(5): 563-566. DOI: 10.1038/sj.eye. 6700457.
39.	Park SP, Ko DA, Chung H, et al. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization in serpiginous choroiditis[J]. Ophthalmic Surg Lasers Imaging, 2006, 37(5): 425-428.
40.	Weiss JN, Benes SC, Levy S. Stem Cell Ophthalmology Treatment Study (SCOTS): improvement in serpiginous choroidopathy following autologous bone marrow derived stem cell treatment[J]. Neural Regen Res, 2016, 11(9): 1512-1516. DOI: 10.4103/1673-5374.191229.
41.	Nazari KH, Rao NA. Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis[J]. Surv Ophthalmol, 2013, 58(3): 203-232. DOI: 10.1016/j.survophthal.2012.08.008.

1. Pivetti-Pezzi P, Accorinti M, La Cava M, et al. Endogenous uveitis: an analysis of 1,417 cases[J]. Ophthalmologica, 1996, 210(4): 234-238.
2. Broekhuyse RM, van Herck M, Pinckers AJ, et al. Immune responsiveness to retinal S-antigen andopsin in serpiginous choroiditis and other retinal diseases[J]. Doc Ophthalmol, 1988, 9(1): 83-93.
3. Abrez H, Biswas J, Sudharshan S. Clinical profile, treatment, and visual outcome of serpiginous choroiditis[J]. Ocul Immunol Inflamm, 2007, 15(4): 325-335. DOI: 10.1080/09273940701375162.
4. Karagiannis DA, Sampat FV, Dowler J. Serpiginous choroidopathy with bilateral foveal sparing and good visual acuity after 18 years of disease[J]. Retina, 2007, 27(7): 989-990. DOI:10.1097/IAE. 0b013e3180592b8e.
5. Priya K, Madhavan HN, Reiser BJ, et al. Association of herpesviruses in the aqueous humor of patients with serpiginous choroiditis: a polymerase chain reaction-based study[J]. Ocul Immunol Inflamm, 2002, 10(4): 247-261. DOI:10.1076/ocii. 10.4.253.15585.
6. Nazari KH, Rao NA. Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis[J].Surv Ophthalmol, 2013, 58(3): 203-232.DOI: 10.1016/j.survophthal.2012.08.008.
7. Vasconcelos-Santos DV, Rao PK, Davies JB, et al. Clinical features of tuberculous serpiginous like choroiditis in contrast to classic serpiginous choroiditis[J]. Arch Ophthalmol, 2010, 128(7): 84784-84788. DOI: 10.1001/archophthalmol.2010.116.
8. Jyotirmay B, Jafferji SS, Sudharshan S, et al. Clinical profile, treatment, and visual outcome of serpiginous choroiditis[J]. Ocul Immunol Inflamm, 2010, 18(1): 46-51. DOI: 10.3109/09273940 903402637.
9. Saurabh K, Panigrahi PK, Kumar A, et al. Profile of serpiginous choroiditis in a tertiary eye care centre in eastern India[J]. Indian J Ophthalmol, 2013, 61(11): 649-652. DOI: 10.4103/0301-4738.119409.
10. Sahu DK, Rawoof A, Sujatha B. Macular serpiginous choroiditis[J]. Indian J Ophthalmol, 2002, 50(3): 189-196.
11. Altan-Yaycioglu R, Akova YA, Akca S, et al. Inflammation of the posterior uvea: findings on fundus fluorescein and indocyanine green angiography[J]. Ocul Immunol Inflamm, 2006, 14(3): 171-179.
12. Cohen SY, Dubois L, Quentel G, et al. Is indocyanine green angiography still relevant?[J] Retina, 2011, 31(2): 209-221. DOI: 10.1097/IAE.0b013e31820a69db.
13. Cardillo PF, Grosso A, Savini E. Fundus autofluorescence in serpiginous choroiditis[J].Graefe’s Arch Clin Exp Ophthalmol, 2009, 247(2): 179-185. DOI: 10.1007/s00417-008-0951-z.
14. Gallagher MJ, Yilmaz T, Cervantes-Castaneda RA, et al. The characteristic features of optical coherence tomography in posterior uveitis[J]. Br J Ophthalmol, 2007, 91(12): 1680-1685. DOI: 10.1136/bjo.2007.124099.
15. Balaskas K, Ur Rehman S, D'Souza Y. Long-term ranibizumab treatment for choroidal neovascularization secondary to serpiginouschoroiditis[J]. Can J Ophthalmol, 2012, 47(5): 15-17. DOI: 10.1016/j.jcjo.2012.03.032.
16. Rifkin LM, Munk MR, Baddar D, et al. A new OCT finding in tuberculous serpiginous-like choroidopathy[J]. Ocul Immunol Inflamm, 2015, 23(1): 53-58. DOI: 10.3109/09273948.2014.964421.
17. Van Velthoven ME, Ongkosuwito JV, Verbraak FD, et al. Combined en-face optical coherence tomography and confocal ophthalmoscopy findings in active multifocal and serpiginous chorioretinitis[J]. Am J Ophthalmol, 2006, 141(5): 972-975. DOI: 10.1016/j.ajo.2005.12.050.
18. Carreño E, Fernandez-Sanz G, Sim DA, et al. Multimodal imaging of macular serpiginous choroidopathy from acute presentation to quiescence[J]. Ophthalmic Surg Lasers Imaging Retina, 2015, 46(2): 266-270. DOI: 10.3928/23258160-20150213-04.
19. Pilotto E, Vujosevic S, Grgic VA, et al. Retinal function in patients with serpiginous choroiditis: a microperimetry study[J]. Graefe’s Arch Clin Exp Ophthalmol, 2010, 248(9): 1331-1337. DOI:10.1007/ s00417-010-1405-y.
20. Shetty SB, Biswas J, Murali S. Real-time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid choroiditis caused by mycobacterium tuberculosis - a case report[J]. J Ophthalmic Inflamm Infect, 2014, 4(1): 29. DOI: 10.1186/s12348-014-0029-5.
21. Rodman J, Pizzimenti J. Serpiginous choroiditis in a herpes-positive patient[J]. Optom Vis Sci, 2011, 88(6): 776-780. DOI: 10.1097/OPX.0b013e3182139357.
22. Mahendradas P, Kamath G, Mahalakshmi B, et al. Serpiginous choroiditis-like picture due to ocular toxoplasmosis[J]. Ocul Immunol Inflamm, 2007, 15(2): 127-130.
23. Mahendradas P, Kamath G, Mahalakshmi B, et al. Serpiginous choroiditis-like picture due to ocular toxoplasmosis[J]. Ocul Immunol Inflamm, 2007, 15(2): 127-130. DOI: 10.1080/0927 3940701244202.
24. Bodaghi B, LeHoang P. Ocular tuberculosis[J]. Curr Opinion Ophthalmol, 2000, 11(6): 443-448. DOI: 10.1097/00055735-200012000-00010.
25. Gupta A, Bansal R, Gupta V, et al. Ocular signs predictive of tubercular uveitis[J]. Am J Ophthalmol, 2010, 149(4): 562-570. DOI: 10.1016/j.ajo.2009.11.020.
26. Nayak S, Basu S, Singh MK. Presumed tubercular retinal vasculitis with serpiginous-like choroiditis in the other eye[J]. Ocul Immunol Inflamm, 2011, 19(5): 361-362. DOI: 10.3109/09273948. 2011.590917.
27. Vasconcelos-Santos DV, Rao PK, Davies JB, et al. Clinical features of tuberculous serpiginouslike choroiditis in contrast to classic serpiginous choroiditis[J]. Arch Ophthalmol, 2010, 128(7): 853-858. DOI: 10.1001/archophthalmol.2010.116.
28. Toniolo J, Hall AJ, Sims J, et al. Retrospective analysis of the natural history and management of serpiginous choroiditis in Australia and New Zealand[J]. Clin Exp Ophthalmol, 2014, 42(7): 656-664. DOI: 10.1111/ceo.12283.
29. Jabs DA, Rosenbaum JT, Foster CS, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel[J]. Am J Ophthalmol, 2000, 130(4): 492-513. DOI:10.1016/S0002-9394 (00)00659-0.
30. Goldstein DA, Fontanilla FA, Kaul S, et al. Long-term follow-up of patients treated with shorttermhigh-dose chlorambucil for sight-threatening ocular inflammation[J]. Ophthalmology, 2002, 109(2): 370-377.
31. Akpek EK, Jabs DA, Tessler HH, et al. Successful treatment of serpiginous choroiditis withalkylating agents[J]. Ophthalmology, 2002, 109(8): 1506-1513.
32. Venkatesh P, Gogia V, Gupta S, et al. Pulse cyclophosphamide therapy in the management of patients with macular serpiginous choroidopathy[J]. Indian J Ophthalmol, 2015, 63(4): 318-322. DOI: 10.4103/0301-4738.158070.
33. Sobaci G, Bayraktar Z, Bayer A. Interferon alpha-2a treatment for serpiginous choroiditis[J]. Ocul Immunol Inflamm, 2005, 13(1): 59-66. DOI: 10.1080/09273940490518865.
34. Seve P, Mennesson E, Grange JD, et al. Infliximab in serpiginous choroiditis[J]. Acta Ophthalmol, 2010, 88(8): 342-343. DOI: 10.1111/j.1755-3768.2009.01738.x.
35. Chinchurreta CA, Requena Jiménez JM, Lorenzo Soto M, et al. Effectiveness of adalimumab for refractory serpiginous-choroiditis[J]. Ocul Immunol Inflamm, 2014, 22(5): 405-408. DOI: 10.3109/09273948.2013.859276.
36. Wadhwa N, Garg SP, Mehrotra A. Prospective evaluation of intravitreal triamcinolone acetonidein serpiginous choroiditis[J]. Ophthalmologica, 2010, 224(3): 183-187. DOI: 10.1159/000252981.
37. Seth RK, Gaudio PA. Treatment of serpiginous choroiditis with intravitreous fluocinolone acetonide implant[J]. Ocul Immunol Inflamm, 2008, 16(3): 103-105. DOI: 10.1080/09273940802023778.
38. Navajas EV, Costa RA, Farah ME, et al. Indocyanine green-mediated photothrombosis combinedwith intravitreal triamcinolone for the treatment of choroidal neovascularization in serpiginous choroiditis[J]. Eye, 2003, 17(5): 563-566. DOI: 10.1038/sj.eye. 6700457.
39. Park SP, Ko DA, Chung H, et al. Photodynamic therapy with verteporfin for juxtafoveal choroidal neovascularization in serpiginous choroiditis[J]. Ophthalmic Surg Lasers Imaging, 2006, 37(5): 425-428.
40. Weiss JN, Benes SC, Levy S. Stem Cell Ophthalmology Treatment Study (SCOTS): improvement in serpiginous choroidopathy following autologous bone marrow derived stem cell treatment[J]. Neural Regen Res, 2016, 11(9): 1512-1516. DOI: 10.4103/1673-5374.191229.
41. Nazari KH, Rao NA. Serpiginous choroiditis and infectious multifocal serpiginoid choroiditis[J]. Surv Ophthalmol, 2013, 58(3): 203-232. DOI: 10.1016/j.survophthal.2012.08.008.

Chinese Journal of Ocular Fundus Diseases

Clinical profile and progress of serpiginous choroiditis

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