セルペンチギノー様脈絡膜炎に対する硝子体内トリアムシノロンアセトニド療法の評価

To evaluate the efficacy and safety of 2 mg intravitreal triamcinolone acetonide (IVTA) in the management of serpiginous-like choroiditis (SLC), and study lesion resolution, recurrence, paradoxical worsening, and systemic medication burden.

This retrospective observational study included patients with SLC receiving 2 mg IVTA with a minimum follow-up of 6 months. Demographic data, clinical findings, imaging, and treatment details were retrieved from medical records. The primary outcomes were time to lesion resolution, incidence of paradoxical worsening, recurrence rate, and the need for repeat IVTA. Secondary outcomes were changes in best-corrected visual acuity (BCVA) and intraocular pressure (IOP). Use of systemic corticosteroids was also recorded.

Fifteen eyes of 14 patients were analyzed. The mean age was 31.5 years, and 71.4% were managed without systemic corticosteroids. All patients received IVTA; 11 received concurrent anti-tubercular therapy (ATT). Mantoux positivity was observed in 64.2%, QuantiFERON-TB Gold in 78.5%, and both were positive in 57.1% of patients. Mean clinical and fundus autofluorescence (FAF)-based lesion resolution time was 2.7 and 5.9 months, respectively. No cases of paradoxical worsening were noted. Recurrence occurred in three eyes, two of which did not receive ATT. Mean BCVA improved from 20/50 to 20/32 (P = 0.006). IOP elevation >21 mm Hg occurred in 33.3% of eyes and was controlled with topical medications. Cataract developed in 38.4% of eyes, and one eye required surgery. The mean follow-up was 18.2 months.

IVTA at a 2 mg dose appears effective in lesion resolution, while minimizing systemic therapy in SLC, with an acceptable safety profile and no paradoxical worsening. Larger prospective studies are needed to validate these findings.