Aravind Eye Hospital, Madurai 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 h/o trauma No h/o cough, fever, weight loss in recent past No h/o urogenital ulcerations No h/o bleeding discariasis No h/o neurological symptoms No h/o any systemic illness

General examination 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 Ocular Examination – OD OS Lids Normal Conjunctiva Cornea Clear Anterior Chamber Normal Depth Iris Normal Colour and Pattern Pupil Normal size and reacting to light Lens Ocular Movements Full Ocular Examination –

Fundus OD: Yellow arrow- healed lesions Red arrow-active lesion over macula OS: healed chorioretinal scars

FFA FFA- Active stage “Block early, stain late” Distinctly insidious Chronic Recurrent variable in size and shape, variable stages of progression, Serpiginous choroiditis

Investigations 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 June 27, 2009 6/60 2 weks later 6/36 3 weeks later 6/24 no recurrences

Thank you Asymptomatic if macula is spared Symptoms GHPC chronic recurrent Often we see a previous scar Early hypo and leak late Asymptomatic if macula is spared Central hypo and leaking borders Vision loss > 2 lines GHPC Symptoms Onset course FFA Active stage FFA Healed stage prognosis Thank you