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.
Purpose To study choroidal vascular abnormal characteristics in choroidal vascular abnormal characteristics in choroiditis using indocyanine green angiography(ICGA). Methods Thirteen cases (16 eyes) of choroiditis were examined with fundus fluorescein angiography (FFA) and ICGA. Results ICGA findings in choroiditis were as follows:(1) dilatation of choroidal vessels with segmentary appearance and irregular margind;(2) hyperpermeability of choroidal vessels;(3) choroidal filling defects; (4) choroidal hypofluorescence with edema;(5) dilatation of vortex veins. (Chin J Ocul Fundus Dis,1998,14:92-84) Conclusion ICGA is useful in evaluating the lesions and circulation disturbance of choroiditis which cannot usually be demonstrable in FFA.
Objective To observe the clinical manifestations and feat ures of fundus fluorescein angiograms(FFA)of patients with multifocal choroiditis (MFC)MethodThe data of 8 patients who had been diagnosed by clinic and FFA as with MFC were collected, and their clinical manifestatio ns and results of FFA were analyzed and valued.ResultsThe age of the 7 female and 1 male patients ranged from 16 to 32, and all of the 8 patients had high myopia (from -6.00 D to -8.00 D) with binocular multiple small yellowish white lesions in posterior pole of the fundus and a few phlogistic ce lls in vitreous body. In addition, macular choroidal neovascularization membrane (CNV) was found in 6 patients, binocular in 2 and monocular in 4. The results of FFA in 7 patients showed hypofluorescence of the yellowish white lesions at t he early phase and pigmentation at the late phase; Corresponding manifestations of FFA could be found in the patients attended by CNV surrounded by leakage.ConclusionMFC are mostly diagnosed in young females with myopia. Most of the patients had binocular affection with multiple small yellowish white lesions at the posterior pole, whose FFA shows hypofluoresence of the active lesions at the early phase and pigmentation at the late phase. CNV may occur in patients with MFC.(Chin J Ocul Fundus Dis，2004，20：335－338)
Objective To observe the clinical effect of photodynamic therapy (PDT）based comprehensive treatment for choroidal neovascularization (CNV) in patients with multifocal choroiditis (MC). Methods Nine eyes of 8 MC patients (7 females and 1 male) with CNV who had undergone PDT based comprehensive treatment were enrolled in this study. The patients aged from 25 to 54 years with the mean of (41.8plusmn;10.6) years. The examinations of best-corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy, fundus fluorescein angiography and optical coherence tomography were performed. The BCVA ranged from 20/333 to 20/50 (mean logMAR 0.68plusmn;0.32). The mean CNV area was (0.767plusmn;0.445) mm2. The central retinal thickness (CRT) was (355.2plusmn;65.2) mu;m. Among the 8 patients,4 eyes received only PDT, 2 eyes received PDT and oral corticosteroid, 1 eye received PDT and intravitreal injection of 1.25 mg bevacizumab, 2 eyes received PDT and subtenon injection of 40 mg triamcinolone acetonide. The follow-up period ranged from 3 to 22 months, with the mean of (14.0plusmn;5.7) months. The BCVA, mean CNV area and CRT before and after treatment were analyzed. Results By the end of last visit, the BCVA improved to 20/250 to 20/25 (mean logMAR 0.58plusmn;0.37), but the difference was not statistically significant (t=1.890, P=0.095). Visual acuity improved 3 lines in 3 eyes (33.3%), improved 1.5 lines in 1 eye (11.1%), unchanged in 4 eyes (44.4%) and decreased 1.5 lines in 1 eye (11.1%). The mean CNV area decreased to (0.684plusmn;0.371) mm2, but the difference was not statistically significant (t=0.996, P=0.349). The CRT decreased to (295.3plusmn;79.4) mu;m, but the difference was not statistically significant (t=2.242, P=0.055). Conclusion PDT can stabilize visual acuity in patients with subretinal CNV secondary to MC, especially when combined with intravitreal injection of antivascular endothelial growth factor drugs or steroid.