Clinical profile, multimodal imaging, and treatment response in macular serpiginous choroiditis
Sushant Madaan1, Kowsigan Magesan2, Aditya Verma1
1Department of Vitreo-Retina, Medical and Vision Research Foundations, Chennai, Tamil Nadu, India.
Purpose:
To describe the clinical profile, multimodal imaging, and treatment response in macular serpiginous choroiditis (MSC).
Methods:
Clinical records of 16 eyes (14 patients) with MSC presenting to a tertiary eye care institute between 2015 and 2019 were analyzed retrospectively.
Results:
Mean age of 14 patients presenting with MSC was 33 ± 13 yrs with 64% males and 36% females. Mean visual acuity of the eyes with MSC at presentation was 0.43 ± 0.46 (logMAR) improving to 0.16 ± 0.28 (logMAR) at final visit. Thirteen eyes (81.3%) had active lesion at presentation. Mantoux test was positive in seven patients (50%) and QuantiFERON TB gold test positive in 10 patients (71%). HRCT chest showed latent tuberculosis in seven patients (50%). All patients underwent multimodal imaging. All patients received oral steroids as treatment therapy; 11 patients also received immunosuppressives, nine patients received additional anti-tubercular therapy (ATT). Mean duration of follow-up for the patients was 18 ± 10 months. A total of eight (50%) eyes had recurrence of lesions after an average duration of 14 ± 14 (3-36) months and were restarted on the treatment as per the requirement. At final follow-up, all eyes showed a good response to treatment and had healed lesions. Comparing the final BCVA to the initial BCVA, 38% (n = 6) showed improvement, 56% (n = 9) remained stable, and 6% (n = 1) eyes worsened at the final follow-up.
Conclusion:
Clinical profile and presentation of MSC is similar to that of CSC, and combination treatment with intravenous methyl prednisolone (IVMP), steroids, immunosuppressives, and ATT can salvage vision. A high suspicion of associated tuberculosis in endemic regions should be kept in mind.
Insights
Macular serpiginous choroiditis (MSC) shares clinical similarities with central serous retinopathy (CSC). Combination therapy including steroids and anti-tubercular therapy (ATT) can effectively manage MSC and preserve vision.
Area of Science:
- Ophthalmology
- Immunology
Background:
- Macular serpiginous choroiditis (MSC) is an inflammatory condition affecting the choroid and retina.
- Its clinical presentation can mimic other macular diseases, necessitating accurate diagnosis and management.
Purpose of the Study:
- To delineate the clinical characteristics, multimodal imaging findings, and treatment outcomes for patients with macular serpiginous choroiditis.
- To evaluate the efficacy of a multimodal treatment approach for MSC.
Main Methods:
- Retrospective analysis of clinical data from 16 eyes (14 patients) diagnosed with MSC between 2015 and 2019.
- Inclusion of multimodal imaging, Mantoux and QuantiFERON TB gold tests, and HRCT chest for tuberculosis screening.
- Assessment of treatment response including visual acuity, lesion activity, and recurrence rates.
Main Results:
- The study included 14 patients (mean age 33 ± 13 years; 64% males).
- Active lesions were present in 81.3% of eyes at presentation, with a significant association with tuberculosis (71% positive QuantiFERON TB gold).
- Combination therapy (steroids, immunosuppressives, ATT) led to healed lesions in all eyes at final follow-up, with 38% showing improved visual acuity.
Conclusions:
- Macular serpiginous choroiditis presents similarly to central serous retinopathy.
- A high index of suspicion for tuberculosis is crucial in endemic areas.
- Multimodal treatment, including anti-tubercular therapy, is effective in managing MSC and salvaging vision.
