Secondary choriocapillaritis in infectious choroiretinitis

Abstract

AbstractPurpose Primary choriocapillaritis is the mechanism at the origin of diseases such as MEWDS, APMPPE, multifocal choroiditis and serpiginous choroiditis. In case of severe chorioretinal inflammation as in infectious posterior uveitis, indocyanine green angiography (ICGA) shows much more widespread involvement than seen by funduscopy or fluorescein angiography (FA) in form of hypofluorescent areas. The aim of this work was to analyse this occult choroidal involvement.Methods Charts of patients with toxoplasmic retinochoroiditis (TRC), syphilitic and tuberculous posterior uveitis seen in the Centre for Opththalmic Specialised Care (COS) in Lausanne, Switzerland from 1995 to 2011 were reviewed and patients with occult choroidal ICGA lesions were analysed.Results Occult ICGA lesions were characterized by a ring of hypofluorescence around the focus as well as small hypofluorescent satellite lesions in TRC and tuberculous posterior uveitis. In syphilitic posterior uveitis the ICGA hypofluorescence was characterized by more extensive areas that could contrast with minimal FA and fundus findings. For all three entities these hypofluorescent areas responded well to treatment, completely regressing in syphilitic posterior uveitis and regressing to a size equivalent to the foci seen on funduscopy and FA.Conclusion The aspect and the quick response to therapy of occult hypofluorescent areas on ICGA seen in severely inflamed infectious posterior uveitis most probably correspond to inflammatory choriocapillaris hypo or non‐perfusion and its extent needs to be assessed by performing a global appraisal of these cases including ICGA.