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Jyotirmay Biswas - One of the best experts on this subject based on the ideXlab platform.
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evaluation of change in the vascular density of choriocapillaris on optical coherence tomography angiography in eyes with Serpiginous Choroiditis
Indian Journal of Ophthalmology, 2020Co-Authors: Amravi Shah, Vinita Rao, Aditya Verma, Jyotirmay BiswasAbstract:Purpose: Serpiginous Choroiditis (SC) is primarily an inflammation of choriocapillaris leading to nonperfusion. A quantitative assessment of choriocapillaris perfusion can be done by measuring the flow-density by OCT-Angiography (OCTA). This study measures a change in the flow-density of choriocapillaris with the resolution of inflammation. Methods: The OCTA images of a choriocapillaris slab of 30 eyes with active SC were subjected to binarization and vessel density was measured at baseline and final visits and compared. Results: Upon comparing the vessel density of the affected areas by OCTA of choriocapillaris-slab at baseline and final visits, there was statistically significant (P
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Enigma of Serpiginous Choroiditis.
Indian journal of ophthalmology, 2019Co-Authors: Parthopratim Dutta Majumder, Jyotirmay Biswas, Amod GuptaAbstract:Serpiginous Choroiditis (SC) is an asymmetrically bilateral inflammation of the choroid that leads to loss of choriocapillaris atrophy or loss of overlying retinal pigment epithelium. Over the last few decades, SC has passed through a long evolution of nomenclature, etiologies and morphological variations. Initially diagnosed in patients with tuberculosis and syphilis, SC was predominantly considered as autoimmune process. With the advancement of molecular diagnosis, a new aspect of infectious subtypes of SC has emerged out. The terminologies such as Serpiginous-like Choroiditis (SLC) and multifocal serpiginoid Choroiditis are now used to denote the subtypes of SC which are associated with infectious etiologies especially tuberculosis. In a country endemic for tuberculosis such as India, it is very important to differentiate between classic SC and SLC before initiating aggressive immunomodulatory therapy. Also, management of paradoxical worsening of the clinical condition with antitubercular treatment is another challenge in SLC and ophthalmologists should be aware of such situations. With advent of newer imaging modalities, monitoring the patient with Choroiditis and identification of complications such as choroidal neovascular membrane have become much easier. This article aims to review the existing literature on SC with a special emphasis on management of SC and SLC.
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Quantitative polymerase chain reaction analysis of Serpiginous Choroiditis with biopsy-proven testicular tuberculosis
Wolters Kluwer Medknow Publications, 2018Co-Authors: Abhinav Dhami, Ranju Kharel, Jyotirmay BiswasAbstract:We report a case of a 47-year-old male patient presenting with diminution of vision in the left eye. The left eye fundus showed yellowish lesions with indistinct geographical margin extending over the posterior pole just abutting the macula, suggestive of diffuse Choroiditis. The patient gave a history of testicular swelling for the past 2 years. Aqueous tap for polymerase chain reaction analysis was positive for IS6110 mycobacterial tuberculosis (TB) genome, and a biopsy of testicular sac was suggestive of tubercular epididymitis. A diagnosis of TB-multifocal serpiginoid Choroiditis was established and was managed with anti-tubercular therapy and systemic steroids
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real time and nested polymerase chain reaction in the diagnosis of multifocal serpiginoid Choroiditis caused by mycobacterium tuberculosis a case report
Journal of Ophthalmic Inflammation and Infection, 2014Co-Authors: Sachin B Shetty, Jyotirmay Biswas, Sowmiya MuraliAbstract:Background The term multifocal serpiginoid Choroiditis (MSC) has been proposed for the infective variant of Serpiginous Choroiditis (SC) to distinguish it from typical SC believed to be autoimmune related. The role of Mycobacterium tuberculosis (MTb) in MSC has been studied by conventional polymerase chain reaction (PCR). However, the use of real-time PCR (RT-PCR) and nested PCR (N-PCR) in MSC has not been reported. This paper aims to highlight the usefulness of PCR in identifying MTb as a causative agent for MSC leading to its correct treatment with anti-tubercular therapy (ATT).
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Serpiginous Choroiditis in a referral clinic in india visual field changes and clinical correlates
Ocular Immunology and Inflammation, 2014Co-Authors: Aliyu Hamza Balarabe, Jyotirmay BiswasAbstract:AbstractPurpose: To report the visual field changes in patients with Serpiginous Choroiditis as seen in a referral clinic in India.Methods: A retrospective noncomparative case series was conducted. Twenty-nine eyes of 17 patients who were diagnosed with Serpiginous Choroiditis were included in the study. Clinical findings were recorded. Visual field was measured with a Humphrey visual field analyzer. Information obtained was entered into SPSS 17.0 and analyzed.Results: There was a male preponderance (8:2). Age at presentation ranged from 14 to 53 years. Eleven subjects (64.7%) had bilateral involvement at presentation. Mean visual acuity improved to 0.35 after treatment. Visual field changes were seen in 28 eyes and the mean deviation value was maintained after treatment (−8.5, 7.19 SD). Multiple foci of defects (usually central or paracentral scotoma co-existing with isolated field defects in the nasal or temporal field) were the commonest form of visual field defect detected.Conclusion: Patients with se...
Byung Ro Lee - One of the best experts on this subject based on the ideXlab platform.
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multimodal imaging including optical coherence tomography angiography in Serpiginous Choroiditis
Ocular Immunology and Inflammation, 2017Co-Authors: Seong Joon Ahn, Seung Hoon Park, Byung Ro LeeAbstract:ABSTRACTPurpose: To report multimodal imaging in patients with Serpiginous Choroiditis.Methods: A 60-year-old woman with active Serpiginous Choroiditis in the right eye was evaluated during the disease course with multimodal imaging, which included fluorescein angiography, swept-source optical coherence tomography (SS-OCT), OCT angiography, fundus autofluorescence (FAF), and retromode imaging.Results: The patient had subretinal, yellowish lesion on the macula at presentation. The margin of the lesion was remarkable in FAF and retromode imaging. SS-OCT scans revealed slightly thickened hyporeflective space and tiny hyperreflective spots at the choriocapillaris level. OCT angiography demonstrated decreased vascularity on the choriocapillaris. Although the area was partially replaced with irregular capillaris, the photoreceptor defect persisted following systemic corticosteroid therapy.Conclusions: Multimodal imaging shows that inflammation of the choriocapillaris is a main pathology of Serpiginous choroidit...
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Multimodal Imaging Including Optical Coherence Tomography Angiography in Serpiginous Choroiditis
2017Co-Authors: Seong Joon Ahn, Seung Hoon Park, Byung Ro LeeAbstract:Purpose: To report multimodal imaging in patients with Serpiginous Choroiditis.Methods: A 60-year-old woman with active Serpiginous Choroiditis in the right eye was evaluated during the disease course with multimodal imaging, which included fluorescein angiography, swept-source optical coherence tomography (SS-OCT), OCT angiography, fundus autofluorescence (FAF), and retromode imaging.Results: The patient had subretinal, yellowish lesion on the macula at presentation. The margin of the lesion was remarkable in FAF and retromode imaging. SS-OCT scans revealed slightly thickened hyporeflective space and tiny hyperreflective spots at the choriocapillaris level. OCT angiography demonstrated decreased vascularity on the choriocapillaris. Although the area was partially replaced with irregular capillaris, the photoreceptor defect persisted following systemic corticosteroid therapy.Conclusions: Multimodal imaging shows that inflammation of the choriocapillaris is a main pathology of Serpiginous Choroiditis. The destruction of the choriocapillaris may lead to the photoreceptor disruption, resulting in permanent visual loss in Serpiginous Choroiditis.
Francesco Bandello - One of the best experts on this subject based on the ideXlab platform.
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swept source optical coherence tomography angiography in Serpiginous Choroiditis
British Journal of Ophthalmology, 2018Co-Authors: Daniela Montorio, Elisabetta Miserocchi, Giulio Modorati, Chiara Giuffre, Riccardo Sacconi, Stefano Mercuri, Lea Querques, Giuseppe Querques, Francesco BandelloAbstract:Background/Aims To analyse choroidal vascular density of affected and non-affected areas in active and inactive SerpiginousChoroiditis (SC) by means of optical coherence tomography angiography (OCT-A). Methods In this cross-sectional and observational study, 22 eyes of 11 patients diagnosed with SC were included. All patients underwent blue-light fundus autofluorescence (spectralis Heidelberg retinalangiography+OCT) and swept-source OCT-A (AngioPlex Elite 9000 SS-OCT, Carl Zeiss Meditech) to analyse qualitative features and choroidal vessel density of areas considered affected, and the inner and the outer border of the lesions. Unaffected areas of otherwise healthy retina have also been studied. Results All inactive inflammatory lesions were characterised by atrophy of choriocapillaris with an impairment of its detectable flow and greater visibility of choroidal vessels. On the other hand, all active inflammatory lesions showed an area of complete absence of decorrelation signal. The pathological border was characterised by a statistically significant lower choroidal vessel density compared with both the outer border and the unaffected area (0.650±0.113 vs 0.698±0.112, (p Conclusion OCT-A represents a new imaging technique that provides useful information about the leading changes of choroidal vascular network in active and inactive lesions of SC.
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dexamethasone intravitreal implant in Serpiginous Choroiditis
British Journal of Ophthalmology, 2016Co-Authors: Elisabetta Miserocchi, Luigi Berchicci, Lorenzo Iuliano, Giulio Modorati, Francesco BandelloAbstract:Background/aims To assess the efficacy and safety of dexamethasone (DEX) intravitreal implant in patients with active Serpiginous Choroiditis (SC) already receiving maximal tolerated systemic immunosuppressive therapy. Methods In this retrospective longitudinal study we evaluated patients receiving 0.7 mg DEX intravitreal implant for active SC despite maximal systemic immunosuppression. Medical history was reviewed over a period of 18 months for each patient. We diagnosed SC activity using direct fundus examination and blue-light fundus autofluorescence. Primary outcomes were the rate of disease control and functional changes at end of follow-up. Secondary outcomes were the incidence of injection-related adverse events and the success of immunosuppression tapering at the last examination. Results We examined eight eyes of seven patients. We controlled SC activity with one injection in five eyes, two injections in one eye, and three injections in two eyes (total of 13 implants). Best-corrected visual acuity at the end of the investigational period improved in two eyes (25%), remained stable in four eyes (50%) and decreased in two eyes (25%). Three eyes showed transient intraocular pressure increase and two eyes disclosed cataract progression. The average dosage of systemic prednisone at baseline and after DEX intravitreal implant decreased from 8.8 to 2.8 mg/day. Conclusions Dexamethasone intravitreal implant may be an effective treatment option to control active Serpiginous lesions in patients in whom increased systemic corticosteroid therapy is contraindicated.
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intravitreal bevacizumab for choroidal neovascularisation in Serpiginous Choroiditis
British Journal of Ophthalmology, 2014Co-Authors: Battaglia M Parodi, Ahmad M. Mansour, Pierluigi Iacono, C La Spina, Karl Anders Knutsson, Jose Fernando Arevalo, Francesco BandelloAbstract:Purpose To assess the effects of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularisation (CNV) secondary to Serpiginous Choroiditis (SC). Design Non-randomised, interventional case series. Participants Seven patients (seven eyes) affected by juxtafoveal CNV (six eyes) and subfoveal CNV (one eye) associated with SC were recruited. Methods Each patient underwent an ophthalmological examination, including measurement of best-corrected visual acuity (BCVA), fluorescein angiography (FA) and optical coherence tomography (OCT). After a first IVB injection (1.25 mg), patients were evaluated monthly over a 12-month follow-up. Further re-treatments were performed on the basis of detection of any type of fluid on OCT and/or presence of leakage on FA. The primary outcome considered was the median change in BCVA, as well as the proportion of eyes gaining at least 5 and 10 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at the end of the 12-month follow-up. Secondary outcomes included median changes in central macular thickness (CMT) and number of injections over the planned follow-up. Results Median BCVA changed from 0.3 to 0.4 LogMAR. A functional improvement of at least 5 and 10 ETDRS letters was obtained in two eyes (28%) and one eye (14%), respectively, at the 12-month examination. Four eyes (57%) had stable BCVA, whereas one eye (14%) experienced a two-line decrease. Median CMT at baseline was 261 μm, decreasing to 196 μm at the 12-month examination. The median number of IVB injections was 1 in 12 months. Conclusions IVB can achieve anatomical stabilisation of CNV secondary to SC, avoiding a decline in visual acuity, in almost 90% of cases over a 12-month follow-up.
Carl P Herbort - One of the best experts on this subject based on the ideXlab platform.
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Serpiginous Choroiditis IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.
Retinal cases & brief reports, 2018Co-Authors: Alaʼa El Ameen, Carl P HerbortAbstract:Purpose:To report a case of Serpiginous Choroiditis imaged with optical coherence tomography angiography (OCT-A).Methods:Case report.Results:Multimodal imaging and OCT-A were performed to investigate Serpiginous Choroiditis in a 65-year-old patient. Comparison between OCT-A images and intermediate a
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Serpiginous Choroiditis sc patterns of progression and role of tuberculous infection
Acta Ophthalmologica, 2010Co-Authors: G Deluigi, Marina Papadia, Luca Cimino, L Cappuccini, Raffaella Aldigeri, Nadia Bouchenaki, Carl P HerbortAbstract:Purpose To relate patterns of progression and role of tuberculosis (TB) infection in Serpiginous Choroiditis (SC) by reviewing a series of cases of SC seen at Centre for Ophthalmic Specialized Care (COS), Lausanne, Switzerland and at the Ophthalmology Department of Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Methods Retrospective review of clinical data, visual field (VF), fluorescein angiographic (FA), indocyanine green angiographic (ICGA) and optical coherence tomography (OCT) features and TB infectious status in cases of SC. Results In the time span of 9 years 16 SC cases were seen in the two centres. Interferon gamma release assays (IGRA) revealed positivity for latent tubercular infection in 11 out of 16 patients. Patterns of evolution under immunosuppressive therapy differed between the TB positive and TB negative cases Conclusion Even in non endemic areas TB infection, as a cause of SC has to be excluded. Typical behaviour of TB related SC is relentless progression despite immunosuppressive therapy.
Narsing A. Rao - One of the best experts on this subject based on the ideXlab platform.
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multifocal Choroiditis Serpiginous Choroiditis and related entities
2019Co-Authors: Hossein Nazari Khanamiri, Narsing A. RaoAbstract:Multifocal Choroiditis (MFC), acute posterior multifocal placoid pigment epitheliopathy (APMPPE), punctate inner choroidopathy (PIC), multiple evanescent white dot syndrome (MEWDS), Serpiginous Choroiditis (SC), multifocal serpiginoid Choroiditis (MSC), birdshot retinochoroidopathy (BRC), and acute zonal occult outer retinopathy (AZOOR) are rare intraocular inflammatory disorders which are grouped under a clinical term of “white dot syndromes.” These syndromes manifest variably with repeated bouts of multifocal retinal and choroidal inflammation and a primary pathologic process that occurs at or near the choroid, the retinal pigment epithelium (RPE), and the outer retina. Their etiology is generally not known, but it is suggested to be either a vasculitic occlusion of the choriocapillaris with secondary ischemia or infarction of the overlying RPE and photoreceptors or an immunologic response directed at the RPE with secondary damage to adjacent choriocapillaris and outer retina. The immunologic trigger for such immune activations is generally unknown.
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Serpiginous Choroiditis and Infectious Multifocal Serpiginoid Choroiditis
Survey of ophthalmology, 2013Co-Authors: Hossein Nazari Khanamiri, Narsing A. RaoAbstract:Serpiginous Choroiditis (SC) is a posterior uveitis displaying a geographic pattern of Choroiditis, extending from the juxtapapillary choroid and intermittently spreading centrifugally. The Choroiditis involves the overlying retinal pigment epithelium, and the outer retina. This intraocular inflammation typically involves both eyes in otherwise healthy, middle-aged individuals with no familial or ethnic predilection. Pathogenesis is unclear; based on limited histopathologic studies, however, favorable response to immunosuppressive agents, and the absence of association with systemic or local infectious or noninfectious diseases, an organ-specific autoimmune inflammation seems likely to be the underlying process. Patients, particularly from tuberculosis-endemic regions, may present with fundus changes simulating SC, but show evidence of active tuberculosis and/or the presence of mycobacterial DNA in the aqueous humor. This has been referred to as Serpiginous-like Choroiditis, but we prefer the description multifocal serpiginoid Choroiditis (MSC). We present the distinguishing features of SC and infectious multifocal serpiginoid Choroiditis simulating SC. The distinction is crucial to avoid unnecessarily treating SC with antimicrobial agents. Advances in diagnostic and imaging modalities can help differentiate SC from MSC. Novel local and systemic treatment approaches improve the outcome and preserve vision in SC.
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clinical features of tuberculous Serpiginouslike Choroiditis in contrast to classic Serpiginous Choroiditis
Archives of Ophthalmology, 2010Co-Authors: Daniel Vitor Vasconcelossantos, Kumar P Rao, John B Davies, Elliott H Sohn, Narsing A. RaoAbstract:Objective To compare distinctive clinical features of presumed tuberculous Serpiginouslike Choroiditis (Tb-SLC) with classic Serpiginous Choroiditis (SC) in patients living in a region that is nonendemic for tuberculosis. Methods Retrospective comparative analysis of clinical features of 5 patients with recurrent Tb-SLC and 5 with SC. Results All patients with recurrent Tb-SLC primarily emigrated from areas highly endemic for tuberculosis and had been unsuccessfully treated with steroids/immunosuppressive agents. Results of uveitis investigations were negative except for positive tuberculin skin test results. These patients received oral tuberculostatic drugs, without recurrences (follow-up, 6-91 months). The ocular involvement in Tb-SLC was mostly unilateral, with multiple irregular serpiginoid lesions involving the posterior pole and periphery but usually sparing the juxtapapillary area. All 5 cases had inflammatory cells in the vitreous. Patients with SC were from areas nonendemic for tuberculosis, had negative uveitis workup findings (including tuberculin skin test results), and were successfully managed with steroids/immunosuppressive agents (follow-up, 6-72 months) with no recurrence. Ocular involvement in SC was usually bilateral, rarely multifocal, and primarily involved the posterior pole, especially around the optic disc and extending contiguously to the macula. No patient with SC presented with vitritis. Conclusion In areas nonendemic for tuberculosis, SC can be clinically differentiated from Tb-SLC. Patients with Tb-SLC come from highly endemic regions, show significant vitritis, and often present with multifocal lesions in the posterior pole and periphery. Cases of SC, in contrast, reveal minimal or no vitritis and frequently show bilateral involvement with larger solitary lesions extending primarily from the juxtapapillary area and sparing the periphery.
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association of herpesviruses in the aqueous humor of patients with Serpiginous Choroiditis a polymerase chain reaction based study
Ocular Immunology and Inflammation, 2002Co-Authors: K Priya, H N Madhavan, Bibiana J Reiser, J Biswas, Rambhatla Saptagirish, K Narayana, Narsing A. RaoAbstract:Purpose: To determine the presence of herpesvirus DNA in the aqueous humor (AH) of patients with Serpiginous Choroiditis using polymerase chain reaction (PCR). Methods: AH from nine patients previously diagnosed with Serpiginous Choroiditis were investigated for herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV) by conventional virological methods and PCR. The PCR-positive DNA was gel-purified, extracted, and sequenced using a dye-based Applied Biosystems procedure. The sequences were processed through the National Cancer Institute’s BLAST inquiry for species identification. Results: Culture and cytological examination of AH from all nine patients were negative for HSV,VZV, and CMV. Five were positive for VZV, one was positive for HSV, and three were wholly negative using PCR. Subsequent DNA sequencing of the positive samples authenticated the presence of VZV and HSV DNA in the respective patients. Conclusion: VZV and HSV DNA were detected in a subset of patients with serp...
