40 years male
BCVA is 6/12 OUN
By Dr.Souad Abdallah Serpigious chorioret,initis, high myopia , PSOH
SC is a rare clinical entity causing less than 5% of posterior uveitis cases. It has a higher prevalence in men and affects young to middle-aged adults. No systemic disease associations have been identified.
Although of unknown etiology, its origin is probably immunogenic since it seems to respond to treatment with cortisteroids and other immunossupressants. Moreover, affected patients also show an increased frequency of HLA-B7 and retinal S-antigen associations. Other pathogenic mechanisms have been proposed and several authors link SC to infectious agents like Mycobacterium tuberculosis and herpes viruses but this remains to be proven.
SC presents with gray-yellowish subretinal infiltrates that usually spread centrifugally from the peripapillary region in a serpiginous (snake-like) manner. Active lesions show a leading edge and resolve with subsequent RPE and choriocapillary atrophy. Consecutive recurrences cause further atrophy leaving hypo and hyperpigmented lesions that spread irregularly over the posterior fundus. Although bilateral, the disease is often asymmetric with multiple lesions in different stages of resolution in both eyes. Recurrences have variable intervals that range from months to years. Anterior chamber and vitritis are minimal. Others forms of SC include Macular serpiginous choroidopathy and Ampiginous choroidopathy (also known as relentless placoid choriorretinitis). The former begins as a macular lesion that spares the peripapillary region with a higher risk of choroidal neovascularization (CNV) and poor visual outcome. Ampiginous choroidopathy is an atypical form of SC characterized by multifocal plaque-like lesions scattered over the posterior pole that resemble acute posterior multifocal placoid pigment epiteliopathy (APMPPE) but without the spontaneous resolution typical of this white-dot syndrome showing multiple areas of atrophy that become contiguous over time.