Título / Title

SERPIGINOUS CHOROIDITIS WITH PERSISTENT MACULAR EDEMA: CASE REPORT

Introdução / Purpose

Serpiginous choroiditis (SC) is a rare ocular inflammatory disease, that can cause irreversible visual loss when macular involvement occurs. Its cause is unknown, but there are studies that consider it an autoimmune process. The diagnosis of SC is typically fundoscopic, and there is no complementary exam that can definitively confirm it.

Material e Método / Methods

Case report of a man, 55 years old, with bilateral SC. Initially with visual acuity with correction 20/400 in right eye (RE) and 20/60 in left eye (LE). Fundoscopy presented vitreitis with macular edema in the RE, and extensive gray white atrophic lesion with pigment mobilization and geographical distribution, with macular involvement in the LE. Fluorescein angiogram showed a characteristic hyperfluorescence of cystoid macular edema in the RE, and a hypofluorescence of early atrophic lesions and progressive hyperfluorescence by staining of thelesion margins in LE.

Resultados / Results

The patient was submitted to subtenon triamcinolone injections in the RE, and oral corticosteroid therapy, with improvement of vitreite, but with persistence of macular edema to OCT. Oral immunosuppression was initiated, and after ninety days of treatment, patient maintains persistent macular edema. Intravitreal dexamethasone implant was proposed.

Discussão e Conclusões / Conclusion

Macular involvement in SC results in low central visual and a difficult treatment since its initial installation phase. Because it is a severe variant, the macular serpiginous requires aggressive treatment. In this case report, despite the therapy used with subtenonian triamcinolone, corticosteroid therapy and oral immunosuppression, no improvement was observed in macular edema. Intravitreal dexamethasone implant appears as a hope of treatment in cases of persistent macular edema in noninfectious uveitis. However, the exact moment when this therapy could have been effective is an indeterminate fact to be considered.

Palavras Chave

Serpiginous choroiditis; Uveitis/diagnosis; Choroiditis