Classification Criteria for Serpiginous Choroiditis

Abstract

Purpose: To determine classification criteria for serpiginous choroiditis.

Design: Machine learning of cases with serpiginous choroiditis and 8 other posterior uveitides.

Methods: Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the infectious posterior uveitides / panuveitides. The resulting criteria were evaluated on the validation set.

Results: One thousand sixty-eight cases of posterior uveitides, including 122 cases of serpiginous choroiditis, were evaluated by machine learning. Key criteria for serpiginous choroiditis included (1) choroiditis with an ameboid or serpentine shape; (2) characteristic imaging on fluorescein angiography or fundus autofluorescence; (3) absent to mild anterior chamber and vitreous inflammation; and (4) the exclusion of tuberculosis. Overall accuracy for posterior uveitides was 93.9% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for serpiginous choroiditis were 0% in both the training set and the validation set.

Conclusions: The criteria for serpiginous choroiditis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

FIGURE 1.

Fundus photograph of a case of serpiginous choroiditis, demonstrating the ameboid chorioretinal lesions.

FIGURE 2.

Fluorescein angiogram of a case of serpiginous choroiditis, demonstrating the characteristic late staining at the borders.