Transcript Folie 1 - Springer Static Content Server

Serpiginous choroiditis/Geographic
helicoid peripapillary choroidopathy
(GHPC)
Dr. Rathinam Sivakumar
HOD - Uveitis Services
Aravind Eye Hospital, Madurai
India
Ocular History
 19 year old male, engineering
student
 presented with c/o sudden onset
painless progressive defect of
vision in OD since 5 days
 no similar complains in the past
General History
 No
 No
 No
 No
 No
 No
h/o
h/o
h/o
h/o
h/o
h/o
trauma
cough, fever, weight loss in recent past
urogenital ulcerations
bleeding discariasis
neurological symptoms
any systemic illness
General examination
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patient moderately built and fairly nourished
conscious, co-operative, oriented to time, place and person
afebrile
no joint swellings
no rashes, nodules, vesicles
no pallor, icterus, cyanosis or lymphadenopathy
BP-110/80 mm Hg
pulse -80 /min, regular, good volume, equal on both sides
General Examination
 CVS - Normal
 RS - Normal
 Abdomen – Normal
 CNS – No focal neurological deficit
 Visual Acuity (Snellen’s)
 OD-6/60
 OS-6/6
Ocular Examination
Lids
Conjunctiva
OD
OS
Normal
Normal
NormalExamination
Normal
Ocular
–
Cornea
Clear
Clear
Anterior Chamber
Normal Depth
Normal Depth
Iris
Normal Colour and Pattern Normal Colour and Pattern
Pupil
Normal size and reacting to
light
Normal size and reacting
to light
Lens
Clear
Clear
Ocular Movements
Full
Full
Fundus
OD:
OS:
Yellow arrow- healed lesions
Red arrow-active lesion over macula
healed chorioretinal scars
 FFA- Active stage
 “Block early, stain late”
FFA
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Distinctly insidious
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Chronic
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Recurrent
 variable in size and shape,
 variable stages of progression,
Serpiginous choroiditis
Investigations
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TLC - 9,600 cells/cumm
DLC – N 58%/ L 30%/ E 12 %
RBC - 3.4 million cells/cumm
Hb – 13.4 gm%
ESR 4mm-30min, 10 mm in 1 hr
Fasting sugar - 73 mg %
Blood urea - 14 mg%
Serum creatinine - 0.9 mg%
Tuberculin skin test (5 ppd) - negative
TPHA – negative
HIV - negative
Diagnosis
 Serpiginious chorioretinitis
 not associated to systemic disorders
Diagnosis based on
 Clinical picture
 FFA findings
 Investigations
 Negative tuberculin skin test
 Negative VDRL
 Normal spiral CT chest
Treatment
 Oral prednisolone 60mg OD
 in tapering doses
Follow ups of the OS
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June 27, 2009
2 weks later
3 weeks later
no recurrences
6/60
6/36
6/24
Symptoms
Asymptomatic if
macula is spared
Onset
chronic recurrent
GHPC
course
FFA Active stage
FFA Healed stage
prognosis
Often we see a previous scar
Early hypo and
leak late
Central hypo
and leaking borders
Vision loss > 2 lines