Choroidopathy

Table of Contents

Fluorescein angiography tests typically detect yellow-white spots on both the choroid and retina, which is then observed by an eye doctor during an evaluation process called fluorescein angiography.

These lesions often progress into choroidal neovascular membranes (CNV), leading to symptoms like floaters and blurry vision. Over time, patients may also experience photopsias and loss of central vision.

Causes

The choroid is an important layer of blood vessels connecting the outer sclera of the eye (sclera) to retina (back of eye), providing nutrients, regulating blood flow and supporting other retinal structures. It can be affected by conditions like age-related macular degeneration, glaucoma and choroidal neovascularization.

Choroidal Neovascularization (CNV) refers to the growth of new blood vessels within the choroid that cause fluid buildup behind the retina, leading to blurred vision or retinal detachments, macular degeneration risk factors or retinal detachments.

CNV can be caused by many different factors, including high blood pressure, diabetes, herpes simplex virus (HSV) infection and inflammation. It may also occur following eye injury, surgery or disease such as cataract, glaucoma or retinal tear.

Other conditions that can negatively affect choroid health include uveitis, macular degeneration and inflammation of vitreous humor. If any of these occur it is imperative that you seek medical advice immediately.

multifocal choroiditis most often affects retinal pigment epithelium (RPE) and Bruch’s membrane, with lesions typically appearing creamy white to yellow and asymmetrically distributed across these structures. Furthermore, multifocal choroiditis often involves mid and far peripheries prior to posterior pole involvement – distinguishing itself from APMPPE and serpiginous choroidopathy which often involve solely posterior pole conditions.

This rare condition is characterized by white, fibrotic subretinal lesions which gradually coalesce into an extensive area of chorioretinal atrophy. Clinical symptoms resemble those seen with histoplasmosis syndrome and sympathetic ophthalmia; precise diagnosis requires thorough examination as well as multimodal imaging studies.

Choroidal melanomas are rare tumors found in the choroid. Most often diagnosed during routine eye exams, they tend to affect Caucasians most commonly and older adults more commonly than other groups. Although their exact causes remain unknown, genetics and environmental factors may both play a part.

Symptoms

Central serous chorioretinopathy (CSCR) is an eye condition commonly experienced by young adults, caused by an accumulation of fluid beneath the retina and manifested as blurred vision and sharpness loss in your central visual field. Although CSC often improves over time, particularly if leaks remain minimal and localized within a small portion of macula; it may become chronic and spread further through macula, leading to retinal detachments or permanent vision loss if leakage spreads to multiple areas or leads to retinal detachments from macula detachments or retinal detachments from macula detachments from macula detachments from macula.

Diagnostic steps involve dilation of the eyes and an eye exam, often supplemented by fluorescein angiography or optical coherence tomography (OCT) tests to confirm diagnosis. Most leaks clear up naturally over time; if symptoms persist however, laser treatment or photodynamic therapy may help seal off leaks and improve vision.

Multiple Evanescent White Dot Syndrome, also referred to as multifocal Chorioretinitis with associated Blind Spot Enlargement syndrome or MCPE-BBE is another form of choroidopathy caused by inflammation from either viral infection or tuberculosis, manifested as small yellow-white lesions located behind the eyeballs. The condition can cause visual distortion.

This condition typically affects people who are very nearsighted, typically between 20-45 years of age. The main symptom is an ever-increasing loss of sharpness in the center of your vision. Other symptoms may include large blind spots, blurry images and floaters. Its exact cause remains unknown but likely involves inflammation and vascular changes; researchers believe a protein responsible for blood vessel formation, mineralocorticoids or other factors may also contribute.

Diagnosis

Choroidopathy can usually be diagnosed by taking a medical history and performing an eye exam. Common symptoms of this condition are blurred vision, floaters or photopsias. An ophthalmoscopic exam typically shows a white-yellow lesion under the retina caused by fluid leaking out from choroid blood vessels lining beneath retina known as “Choroids,” leading to serous retinal detachments as a result of leakage from under retina blood vessels (Choroid).

Choroidal Neovascular Membranes (CNV), an eye condition in which new blood vessels form under the retina, is one of the primary causes for detached retina and macular degeneration.

Central serous chorioretinopathy (CSC), an inflammatory condition in which fluid accumulates under the retina, typically affects young and middle-aged adults. CSC can be treated using photodynamic therapy, focal laser treatments and mineralocorticoid receptor antagonist medications such as mineralocorticoid antagonists.

A 65-year old woman with chronic hypertension, schizophrenia and renal insufficiency presented with decreased vision. She described it as being no longer possible to read or drive and described her vision as being like that of a gray bubble in the center of her field – something which was further exasperated by bright lighting conditions. Her visual acuity was 20/70 OD on evaluation; fluorescein angiography revealed early and late dye leakage from active lesions on CSC, as demonstrated by early and late dye leakage from active lesions as shown by fluorescein angiography while Indocyanine green angiography revealed smokestack pattern leakage along with dilation of capillaries and veins seen via OCT scan.

In this installment, we will review three cases of choroidopathy successfully managed with photodynamic therapy and focal laser treatment as well as mineralocorticoid receptor antagonists. This shows the value of multimodality for treating difficult to treat disorders. Dr. Moorthy serves as an assistant clinical professor of ophthalmology and director of Wishard Hospital Uveitis Service at Indiana University School of Medicine.

Treatment

Choroidopathy tends to resolve itself within six months in most cases, with symptoms typically subsiding on their own. They include blurred vision, distortions appearing and decreased ability to see fine detail; severe cases may even result in blindness. Conservative treatment may include anti-inflammatory medication or injections into the eye with steroids; additionally, physicians may suggest other options like photodynamic therapy or intravitreal drug administration of anti-VEGF or mineralocorticoid receptor antagonist drugs.

Central Serous Chorioretinopathy (CSCR) is a chronic inflammatory disease of the retina and choroid that typically affects adults between 30-60, typically women more frequently than men. Also referred to as Idiopathic Central Serous Retinopathy or Multiple Evanescent White Dot Syndrome /Central Serous Retinitis it’s one of the many names used for it.

Symptoms of CSCR include blurred vision and the appearance of distorted images. Vision may become so poor that patients cannot drive or read. Although its cause remains unknown, experts suspect it could be related to inflammation and changes in the eye’s vascular system; thickened and dilated choroidal blood vessels in particular become thickened and dilatant leading to fluid leakage as permeability of these blood vessels also increases during CSCR.

Diagnostic of CSCR can be achieved via ophthalmoscopy. An ophthalmologist will search for small creamy-white to yellow-white lesions located in the center of retina that resemble buckshot fired from a shotgun; hence the name. They should also check for signs of serous detachment such as floaters. Finally, spectral domain optical coherence tomography may reveal subretinal fluid or overlying choroidal neovascularization on an OCT scan.

Photodynamic therapy and laser photocoagulation were previously recommended to treat CSCR; however, they have become less frequently recommended since drug treatments that neutralize soluble isoforms of VEGF have proven more successful at improving visual acuity for many patients with exudative AMD; thus replacing both of these therapies in most cases of CNV due to AMD1. Furthermore, drug delivery systems that directly administer anti-VEGF medications into the eye have also been developed1.

About the Author:
Picture of Alexander Suprun

Alexander Suprun

Alex started his first web marketing campaign in 1997 and continues harvesting this fruitful field today. He helped many startups and well-established companies to grow to the next level by applying innovative inbound marketing strategies. For the past 26 years, Alex has served over a hundred clients worldwide in all aspects of digital marketing and communications. Additionally, Alex is an expert researcher in healthcare, vision, macular degeneration, natural therapy, and microcurrent devices. His passion lies in developing medical devices to combat various ailments, showcasing his commitment to innovation in healthcare.

Macular
Degeneration?

Stop It Now...

Related Posts
shop cartShop Best Low-Vision Aids with FREE Doctor Consultation.Yes! Let's Go