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Chapter-22 Inflammatory Choriocapillaropathies

BOOK TITLE: Uveitis: Text and Imaging

Author
1. Gupta Amod
2. Gupta Vishali
3. Herbort Carl P
4. Mantovani Alessandro
5. Agarwal Anita
6. Caspers Laure
7. Sachdev Nishant
ISBN
9788184484915
DOI
10.5005/jp/books/11002_22
Edition
1/e
Publishing Year
2009
Pages
82
Author Affiliations
1. Advanced Eye Centre, Postgraduate Institute of Medical, Education and Research, Chandigarh, India, Postgraduate Institute of Medical, Education and Research, Chandigarh, India
2. Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh (India), King Khaled Eye Specialist Hospital, Riyadh, KSA, Postgraduate Institute of Medical, Education and Research, Chandigarh, India, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
3. University of Lausanne and Inflammatory and Retinal Eye Diseases, Centre for Ophthalmic Specialised Care, Lausanne, Switzerland
4. Ospedale Valduce, Como, Italy
5. Vanderbilt Eye Institute, Nashville, Tennesse, USA
6. St Pierre University Hospital (ULB), Brussels, Belgium
7. Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
Chapter keywords
inflammatory choriocapillaropathies, intraocular inflammations, Indocyanine green angiography, hypofluorescent dark dots, secondary stromal choroiditis, primary inflammatory choriocapillaropathies, choroidal stromal space, ischaemic consequences, choroidal compartment, white dot syndromes

Abstract

This chapter provides an overview of inflammatory choriocapillaropathies. The choroid is the site of origin of posterior intraocular inflammations at least as often if not more often than the retina. Indocyanine green angiography (ICGA), for the first time gave a relatively sensitive imaging access to the choroidal compartment allowing a more detailed investigation of the choroid. Indocyanine green (ICG) fluoresces at 830 nm which is in the infrared spectrum and, therefore, gives access to the choroid, in particular to choroidal vascular structures through the RPE. Choroidal impregnation by ICG fluorescence is disturbed by choroidal inflammatory lesions (foci), causing mostly areas of decreased or absent fluorescence. Impregnation of the choroidal stromal space can be enhanced (hyperfluorescence) by increased leakage from the larger choroidal vessels that are normally impermeable. Primary inflammatory choriocapillaropathy presents inflammation at the level of the choriocapillaris. This causes areas of choriocapillaris non perfusion with its ischaemic consequences both at the level of the choroid and at the level of the outer retina that depend on the choriocapillaris for oxygen and nutrients. In primary stromal choroiditis, the primary mechanism is the development of inflammatory foci, mostly granulomatous at the level of the stroma appearing as hypofluorescent dark dots (HDDs) on ICGA. In secondary stromal choroiditis, unlike in primary stromal choroiditis, the target of the inflammatory reaction is not situated obligatorily within the choroid but the choroidal stroma is only one of the locations where a systemic inflammatory disease such as sarcoidosis or a systemic infectious disease such as tuberculosis elect to produce a lesion. Indocyanine green angiographic signs in PICCPs are well determined and have contributed to the recognition of the common mechanism involved and to regroup these entities formerly classified under the term of “white dot syndromes”. Primary inflammatory choriocapillaropathies are occurring with predilection in young adults. Systemic symptoms such as a flue like and/or febrile episode preceding the ocular disease can be found in 50-60% of cases indicating a possible viral or other infectious or systemic trigger at the origin of inflammatory choriocapillaropathies.

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