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Solitary Idiopathic Choroiditis
The Richard B. Weaver Lecture
Jerry A. Shields, MD;
Carol L. Shields, MD;
Hakan Demirci, MD;
Santosh Hanovar, MD
Arch Ophthalmol. 2002;120:311-319.
Objective To report the clinical characteristics of solitary idiopathic choroiditis
and the features that differentiate it from tumors and other inflammatory
lesions.
Design Retrospective medical record review.
Patients Sixty consecutive patients with solitary idiopathic choroiditis.
Main Outcome Measures Clinical features, natural course, and follow-up.
Results The mean and median ages of the patients were 35 and 36 years, respectively,
56 (93%) of the 60 patients were white, 38 (63%) were female, and 22 (37%)
were male. No patient had a history, clinical findings, or laboratory study
results to support a specific cause of uveitis. All were referred to us because
of a suspected intraocular tumor. The patient was asymptomatic in 21 cases
(35%); the patient had mild visual loss in 36 cases (60%). The lesion was
posterior to the equator in 56 cases (93%), was yellow in 58 cases (97%),
and had distinct margins in 38 cases (63%). The lesion showed signs of active
inflammation in 20 cases (33%) and no inflammation in 40 cases (67%). Fluorescein
angiography disclosed that all lesions had early hypofluorescence and late
hyperfluorescence. In the late-phase angiograms inactive lesions had distinct
margins and active lesions had ill-defined margins. Lesions with active inflammation
appeared to show a favorable response to the administration of systemic corticosteroids
but generally improved with or without treatment. Most of the inactive lesions
remained stable on long-term follow-up. Overall, the condition remained stable
in 36 patients (60%), improved in 22 (37%), and recurred in 2 (3%). The clinical
and angiographic features and clinical course of solitary idiopathic choroiditis
were generally different from known intraocular tumors.
Conclusions Solitary idiopathic choroiditis is a distinct clinical entity that can
simulate an intraocular neoplasm. Recognition of its typical clinical features
can assist in differentiating it from tumors and other inflammatory lesions
of the ocular fundus.
From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson
University, Philadelphia, Pa.
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