Multimodal imaging-detected choroidal neovascular membrane in serpiginous-like choroiditis successfully treated with combined immunosuppressive and antivascular endothelial growth factor therapy

ABSTRACT Serpiginous-like choroiditis (SLC) is a rare, progressive inflammatory disorder affecting the choriocapillaris, retinal pigment epithelium, and outer retina. It is often associated with infectious etiologies such as tuberculosis but may also occur as an immune-mediated condition. One of the most vision-threatening complications is the development of choroidal neovascular membrane (CNVM), which can result in significant visual loss if not treated promptly. A 47-year-old Indian male presented with bilateral diminution of vision for 2 weeks. Best-corrected visual acuity was 20/125 in the right eye and 20/80 in the left eye. Fundus examination revealed multifocal, asymmetrical SLC lesions in both eyes. Multimodal imaging, including fundus autofluorescence, optical coherence tomography (OCT), and OCT angiography, confirmed active inflammation and CNVM in the right eye. Systemic evaluation for infectious causes, including tuberculosis, syphilis, and human immunodeficiency virus, was negative. The patient was treated with systemic corticosteroids, oral methotrexate, and intravenous methylprednisolone. Intravitreal ranibizumab injection was administered for CNVM. At 3-month follow-up, regression of choroidal neovascularization and resolution of active inflammation were observed. Visual acuity improved to 20/63 in the right eye and 20/40 in the left eye, with stabilization of retinal lesions. SLC can lead to severe visual impairment due to complications such as CNVM. Multimodal imaging is essential for early diagnosis and monitoring. Combined immunosuppressive therapy and intravitreal antivascular endothelial growth factor treatment can result in favorable anatomical and visual outcomes. Early recognition and prompt management are critical to prevent permanent visual loss.