Abstract
Purpose To describe spectral domain optical coherence tomography (SD-OCT) and enhanced depth image OCT (EDI-OCT) findings of multifocal serpiginoid choroditis (MSC) , including affected layer of retinal involvement, changes at the vitreoretinal interface, and response to therapy. Methods A retrospective review of 20 eyes (14 patients) with MSC. Each patient underwent a complete ophthalmologic examination, fundus photography, fundus autoflorecence (FAF) and OCT imaging of the affected retina at the initial visit and on each follow-up. Results In acute stage, SD-OCT showed hyperreflective areas involving the outer retinal layers which include retinal pigment epithelium (RPE), photoreceptor outer segment tips (POST), inner segment–outer segment (IS/OS) junction, external limiting membrane (ELM), and outer nuclear layer (ONL) with choroidal and intraretinal layer cells infiltrate. EDI-OCT showed increase choroidal thickness. As the lesions began to heal, irregular, knobby elevations of outer retinal layers appeared (RPE, POST, IS/OS junction, and ELM could not be distinguished) with significant decrease in choroidal and intraretinal cells. On complete healing, loss of RPE, POST, IS/OS junction, and ELM in SD-OCT scan and absent of the choroidal and intraretinal cells and continous hyperreflactivity of the choroid (increased penetrance). Conclusion SD-OCT and EDI-OCT provides high-resolution detail regarding ultrastructural changes in vitreoretinal interface, outer retina and choroid during the course of the lesion. Serial SD-OCT and EDI-OCT also provides further insight into response to therapy by observing choroidal and intraretinal cells.
Highlights
Serpiginous choroiditis is a progressive, chronic, recurrent inflammatory disease primarily affecting the inner choroid and retinal pigment epithelial (RPE) cell layer.[1]
Serpiginoid multifocal choroiditis (MSC) is a distinct clinical entity that begins usually as multifocal choroiditis lesions that coalesce and progress in a serpiginoid pattern. (MSC) a designation that better reflects the clinical features of presumed tubercular etiology and is preferable to the previously used serpiginous-like choroiditis(SLC).[2]
We describe the changes in high-resolution spectral domain optical coherence tomography (SD-optical coherence tomography (OCT)) scans that were simultaneously obtained with fundus autoflorecence (FAF) signals on Spectralis HRA+OCT in 14 patients with MCS who were followed from the stage of acute lesion to the healed stage over a period of 3–6 months
Summary
Serpiginous choroiditis is a progressive, chronic, recurrent inflammatory disease primarily affecting the inner choroid and retinal pigment epithelial (RPE) cell layer.[1]. Since its introduction in 1991, optical coherence tomography (OCT), has found its place as a widely accepted imaging technique, especially in ophthalmology and other biomedical applications. It represents an interferometric, non-invasive optical tomographic imaging technique offering millimetre penetration with submicrometre axial and lateral resolution.[4]. The simultaneous recordings of topographic and tomographic images by using combination of scanning laser ophthalmoscopy and optical coherence tomography (OCT) have increased our understanding of the pathogenesis of various diseases of the retina and choroid.[3] The Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany) is a novel multimodal imaging device that enables us to correlate confocal angiograms, fundus autofluorescence (FAF) images, and other imaging modes with the high resolution spectral domain (SD)-OCT scans.3The Spectralis HRA+OCT has been used in imaging the choroid in intraocular inflammation using the inverted scan technique
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