Killer cases due to occult choroidal inflammation : how to prevent them

Abstract

Purpose Inflammation of the choroid evolves mostly unnoticed when only clinical examination and/or only classical investigational methods are used. In some cases such occult inflammation, when it is finally noted has already caused irremediable damage. Methods Inflammatory cases are presented that showed minimal or no signs on clinical examination/investigational tests, where significant occult choroïdal inflammation was detected by ICGA and that responded to therapy initiated on the base of ICGA findings. In parallel, patients that were treated with delay or received no therapy and suffered irremediable damage will be presented. Results Primary inflammatory choriocapillaropathies PICCPs (MEWDS, APMPPE, multifocal choroiditis) known to be caused by inflammatory choriocapillaris non perfusion can only be meaningfully investigated for activity by ICGA as non‐perfused areas are not seen otherwise. If active disease (non‐perfusion) is suspected, PICCPs have to be evaluated and followed by ICGA and in case of persistence of non‐perfusion and worsening of function, therapy has to be introduced to avoid irremediable damage. For stromal choroiditis such as Vogt‐Koyanagi‐Harada (VKH) disease, persisting choroiditis after alleged clinical recovery needing continued therapy can only be shown by ICGA, so avoiding complications due to smouldering occult disease. Conclusion ICGA in the work‐up of posterior uveitis should be part of a routine investigation for those case where angiographic work‐up is deemed necessary.