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LETTER TO EDITOR
Year : 2005  |  Volume : 53  |  Issue : 1  |  Page : 77-79
 

Intravitreal Triamcinolone Acetonide in Serpiginous Choroidopathy


Smt. Kannuri Santhamma Retina Vitreous Center, L V Prasad Eye Institute, India

Correspondence Address:
Avinash Pathengay
Smt. Kannuri Santhamma Retina Vitreous Center, L V Prasad Eye Institute, L V Prasad Marg, Banjara Hills, Hyderabad - 500 034
India
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DOI: 10.4103/0301-4738.15295

PMID: 15829756

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How to cite this article:
Pathengay A. Intravitreal Triamcinolone Acetonide in Serpiginous Choroidopathy. Indian J Ophthalmol 2005;53:77-9

How to cite this URL:
Pathengay A. Intravitreal Triamcinolone Acetonide in Serpiginous Choroidopathy. Indian J Ophthalmol [serial online] 2005 [cited 2014 Oct 24];53:77-9. Available from: http://www.ijo.in/text.asp?2005/53/1/77/15295


Serpiginous choroidopathy is a chronic inflammatory chorioretinopathy which extends from the optic disc to macula and peripheral retina in a helicoid or geographic pattern.[1] The management depends upon the stage of the disease. Systemic immunosuppression is the mainstay of treatment in active stage.[1] We report a patient of serpiginous choroidopathy treated with intravitreal triamcinolone acetonide (IVTA) where oral corticosteroid was contraindicated because of a co-existing peptic ulcer.

A 40-year-old man presented with complaint of reduction of vision in left eye for the past one month. His best-corrected visual acuity was 6/6, N6 in the right eye and 6/24, N36 in the left eye. The anterior segment examination was normal and intraocular pressure was 14 mmHg in both eyes. The fundus examination of the both eyes showed vitreous cells with peripapillary areas of chorioretinal atrophy involving the central macula of left eye. Contiguous and non contiguous active choroidal inflammatory lesions were observed [Figures 1a and b]. Active lesion on fluorescein angiography was hypoflourescent in the early phase with staining observed in the late phase [Figures 2a and b]. Oral corticosteroid was ruled out due to co-existing peoptic ulcer. The patient could not afford cyclosporin. He received IVTA 4 mg in 0.1 ml in both eyes under aseptic conditions. At one month's follow up vision in the right eye was stable and in the left eye was 6/18, N24. Vitritis and choroidal inflammation had regressed clinically [Figures 1c and 1d]. On fluorescein angiogram the late staining from active lesions had resolved [Figures 2c and d]. Clinical and angiographic remission obtained at the end of one month was maintained at the end of 10 months. Rise of intraocular pressure was not observed during the follow up.

The natural course of serpiginous choroidopathy is characterised by multiple recurrences.[1] Visual loss results from macular involvement or from secondary choroidal neovascularisation. In the active stage systemic immunosuppression is the mainstay of treatment.[1],[2] Immunosuppression ranges from monotherapy with either oral corticosteroids or cyclosporin to triple therapy.[1],[2] Patients with history of peptic ulcer may experience aggravation of symptoms with conventional doses of oral corticosteroid.[3] IVTA delivers the desired concentration of the drug without extraocular side effects. The long half-life of IVTA is beneficial for various retinal conditions including uveitis.[4] In our patient the rapid remission observed clinically and angiographically in the first month persisted till the end of 10 months. Currently the patient is being followed up to note the late effects and recurrence.

To conclude, IVTA can prevent progression and induce remission in serpiginous choroidopathy. Further case -control studies are required to validate this initial observation.

 
   References Top

1.Weiss H, Annesly WJ, Shields JA. The clinical course of serpiginous choroidopathy. Am J Ophthalmol 1979;87:133-42.  Back to cited text no. 1    
2.Hooper PL, Kaplan HJ. Triple agent immunosuppression in serpiginous choroiditis. Ophthalmology 1991;98:944-51.  Back to cited text no. 2  [PUBMED]  
3.McGuigan JE, Peptic Ulcer and Gastritis In: Isselbacher K.J, Braunwald, Wilson JD, Martin JB, editors. Harrison's Principles of Internal Medicine. 13th Ed. McGraw-Hill, Inc. 1994. Vol. 2, pp 1363-81.  Back to cited text no. 3    
4.Antcliff RJ, Spalton DJ, Stanford MR, Graham EM, ffytche TJ, Marshall J. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology 2001;108:765-72.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]


Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]


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