Retrospective analysis of the natural history and management of serpiginous choroiditis in Australia and New Zealand

• Published in: Clinical & experimental ophthalmology 2014-09, Vol.42 (7), p.656-664
• Main Authors: Toniolo, Jason, Hall, Anthony J, Sims, Jo, Fraser-Bell, Samantha, Khan, Jane, Younan, Christine, Kent-Smith, Brian, Young, Stephanie, Paul, Eldho, Lim, Lyndell L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Australia - epidemiology; choroiditis; Choroiditis - diagnosis; Choroiditis - drug therapy; Choroiditis - epidemiology; Cohort Studies; Confidence intervals; Drug therapy; Drug Therapy, Combination; European Continental Ancestry Group; Female; Follow-Up Studies; Glucocorticoids - therapeutic use; Humans; immunosuppression; Immunosuppressive Agents - therapeutic use; Incidence; Male; Medical research; Middle Aged; New Zealand - epidemiology; Prevalence; Recurrence; Retrospective Studies; steroid; uveitis
• ISSN: 1442-6404; 1442-9071
• DOI: 10.1111/ceo.12283

Background To examine the prevalence of serpiginous choroidopathy in a predominantly Caucasian community, to examine associations between serpiginous choroiditis and other systemic diseases, and to report on the effect of immunosuppression on the long‐term course of serpiginous choroiditis. Design Retrospective cohort study with patients from tertiary care centres and private practices. Participants 18 patients, mean age 48 years at baseline. One patient was seen only once. Median follow‐up was 69 months (5.8 years, range 0.4–29.7 years). Methods Patients were identified using the Australian and New Zealand Ophthalmic Surveillance Unit. A chart analysis was performed for all patients. Three treatment groups were identified: no treatment, prednisolone monotherapy, or combination of prednisolone and immunosuppression. Negative binomial regression was used to calculate incidence rate ratios for patient relapse. Main Outcome Measures Patient demographics, clinical features, associated systemic diseases, treatments administered and dates of relapse. Results The disease prevalence in Australia and New Zealand is 1 case per 1.5 million people. Five cases (28%) had a positive QuantiFERON. A total of 32 relapses were observed: 14 while receiving no treatment, 11 on prednisolone and 7 on combination therapy. Compared with the no treatment group, the incidence rate ratio for prednisolone monotherapy and combination therapy was 1.29 and 2.92, respectively (95% confidence interval 0.40–4.14 and 0.96–8.88). Conclusion Although the confidence intervals indicate that the difference in incidence rate ratios are not significant, these results suggest that there is a group of patients who have a benign course without long‐term immunosuppression or corticosteroid treatment.