Serpiginous Choroiditis; Clinical Features, Diagnosis, and Treatment

Serpiginous choroiditis is a progressive disease that causes atrophy in layers of the choriocapillaris, retinal pigment epithelium, and photoreceptor, due to choroidal inflammation. It typically involves both eyes asymmetrically and spreads from the peripapillary area to the periphery. Although the etiology is unclear, an autoimmune and infectious mechanism seems likely to be the underlying process. The clinical condition is called “multifocal serpiginous choroiditis” if an underlying infectious cause such as Mycobacterium tuberculosis, Treponema pallidum, or herpesviruses is detected. The natural course of the disease usually consists of multiple recurrences of choroidal inflammation over a period of months to years. The vision loss occurs if the fovea is involved during these relapses. Multimodal imaging methods are important in the diagnosis, treatment, follow-up of the disease, and the detection of complications such as choroidal neovascularization. In treatment, it is aimed to suppress inflammation and prevent recurrences via systemic/local corticosteroids and immunomodulatory drugs. If an underlying infectious agent is detected, specific antimicrobial treatment should also be added.