Enigma of serpiginous choroiditis

Area of Science:

• Ophthalmology
• Immunology
• Infectious Diseases

Background:

• Serpiginous choroiditis (SC) is an inflammatory eye condition affecting the choroid and retinal pigment epithelium.
• Historically viewed as autoimmune, recent advances reveal infectious etiologies, particularly tuberculosis.
• Nomenclature and understanding of SC have evolved, with subtypes like serpiginous-like choroiditis (SLC) now recognized.

Purpose of the Study:

• To review the literature on serpiginous choroiditis (SC).
• To emphasize the differentiation between classic SC and infectious subtypes (SLC).
• To highlight management challenges and strategies for SC and SLC, especially in tuberculosis-endemic areas.

Main Methods:

• Literature review of serpiginous choroiditis (SC) and related conditions.
• Analysis of diagnostic evolution, from clinical presentation to molecular diagnostics.
• Discussion of therapeutic approaches, including immunomodulatory and anti-infective treatments.

Main Results:

• SC classification has evolved, recognizing infectious causes like tuberculosis (leading to SLC).
• Accurate differentiation between SC and SLC is vital before initiating immunosuppressive therapy.
• Paradoxical worsening during anti-tubercular treatment in SLC requires specific ophthalmologist awareness.

Conclusions:

• Distinguishing between classic SC and infectious SLC is critical for effective patient management.
• Early and accurate diagnosis, considering infectious etiologies, guides appropriate therapeutic decisions.
• Advanced imaging aids in monitoring SC/SLC and detecting complications like choroidal neovascularization.