Vitreous & Retina

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Infectious / Inflammatory Disorders
An active lesion with a relatively sharp border involving the macula of the left eye was noted. New lesions that are contiguous with the prior lesions are seen in the superotemporal region.
Serpiginous choroiditis with mild vitreous reaction.

  • Rare, chronic, bilateral inflammatory disorder
  • Recurrences are common
  • Onset is usually between ages 30 and 70 years
  • Clinical features:
    • Symptoms:
      • Painless blurring of vision with central or paracentral scotoma
      • Metamorphopsia due to macular involvement
    • Signs:
      • Acute onset lesion: gray-yellowish discoloration of the RPE with a pseudopodial configuration extending in a centrifugal manner from the optic disc
      • Acute lesions normally last in several weeks, followed with development of chorioretinal atrophy and RPE migration along the large choroidal vasculature
      • Previous inflammation is evidence with areas of atrophic RPE, choriocapillaris and pigment clumpings
      • New lesions are often contiguous with the chronic lesions
      • Can be complicated with choroidal neovascularization
  • Fluorescein angiogram demonstrates:
    • Acute lesions: hypofluorescence in the early phases and hyperfluorescence with leakage or staining of the lesion evolving centrally in the mid to late phases
    • Mottled hyperfluorescence due to pigment clumping in chronic lesions
  • Electrophysiologic studies are normal.
  • Occasional cases have been associated with the administration of anti-tuberculosis drugs.
  • Management:
    • Self assessment with Amsler grid test
    • Triple immunosuppression with; systemic corticosteroid, acyclovir and cyclosporin in vision threatening cases, such as macular or papillomacular involvement.
    • Laser photocoagulation and submacular surgery in cases complicated with choroidal neovascularization.

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