Serpiginous choroiditis

Serpiginous choroiditis, also known as geographic helicoid peripapillary choroidopathy or serpiginous choroidopathy, is a rare, chronic, progressive inflammatory eye disease that primarily affects the choroid and retinal pigment epithelium (RPE). The condition is characterized by recurrent episodes of inflammation that typically begin around the optic disc (peripapillary region) and extend outward in a serpentine or snake-like pattern, leading to progressive destruction of the choroid and overlying RPE. It predominantly affects the posterior segment of the eye and can be unilateral or bilateral, though bilateral involvement is more common. Patients typically present with blurred vision, central or paracentral scotomas (blind spots), and metamorphopsia (visual distortion). The disease follows a relapsing and remitting course, with each recurrence causing further atrophy of the choroid and RPE. When the macula becomes involved, significant and often permanent visual loss can occur. The condition most commonly affects otherwise healthy adults, typically between the ages of 30 and 70, with a slight male predominance reported in some series. The exact cause of serpiginous choroiditis remains unknown, though an autoimmune mechanism targeting choroidal vasculature is suspected. An association with tuberculosis has been described in endemic regions, leading to the concept of tubercular serpiginous-like choroiditis, which must be distinguished from the idiopathic form. Treatment typically involves systemic immunosuppressive therapy, including corticosteroids, antimetabolites (such as azathioprine or mycophenolate mofetil), and alkylating agents (such as cyclophosphamide) for refractory cases. Anti-VEGF agents and biologic therapies have also been used in select cases. In tubercular serpiginous-like choroiditis, antitubercular therapy is a critical component of management. Early and aggressive treatment is important to limit disease progression and preserve vision.

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