Serpijinöz Koroidit; Klinik Özellikler, Tanı ve Tedavi

Serpijinöz koroidit, koroid inflamasyonu nedeniyle koryokapillaris, retina pigment epiteli ve fotoreseptör tabakada atrofiye neden olan progresif bir hastalıktır. Genellikle asimetrik bilateral tutulum yapar ve peripapiller alandan perifere doğru yayılır. Etyolojisi bilinmemekle birlikte ön planda otoimmun ve enfeksiyöz mekanizmalar suçlanmaktadır. Eğer Mycobacterium tuberculosis, Treponema pallidum ya da herpesvirusler gibi altta yatan enfeksiyöz bir neden bulunursa, klinik durum “multifokal serpijinoid koroidit” olarak adlandırılır. Hastalığın doğal seyrinde aylar ya da yıllar içinde koroidal inflamasyon defalarca nüks eder. Bu nüksler sırasında fovea tutulursa görme kaybı gelişir. Hastalığın tanı, tedavi, takibinde ve koroidal neovaskülarizasyon gibi komplikasyonların tanınmasında multimodal görüntüleme yöntemleri önemlidir. Tedavide amaç sistemik/lokal kortikosteroidler ve immunmodulatör ilaçlar ile inflamasyonun baskılanması ve nükslerin önlenmesidir. Altta yatan enfeksiyöz bir neden varsa etkene yönelik antimikrobiyal tedavi yapılmalıdır.

Serpiginous Choroiditis; Clinical Features, Diagnosis and Treatment

Serpiginous choroiditis is a progressive disease that causes atrophy in layers of 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, autoimmune and infectious mechanisms seems likely to be underlying process. The clinical condition is called “multifocal serpiginoid 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 multipl 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 supress 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.

Kaynakça

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