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Serpiginous-like choroiditis-as a marker for tuberculosis in a non-endemic area

Session Details

Session Title: Quick Fire Free Paper 3

Session Date/Time: Thursday 11/09/2014 | 14:30-16:00

Paper Time: 15:40

Venue: Boulevard D

First Author: : W.Gan UK

Co Author(s): :    N. Jones              

Abstract Details

Purpose:

To describe the increasing incidence of multifocal outer retinal and inner choroidal inflammation, as a marker for intraocular tuberculosis in the United Kingdom, a non-endemic area.

Setting:

Manchester Royal Eye Hospital, United Kingdom.

Methods:

Retrospective case series. Patients diagnosed with uveitis confirmed or presumed to be associated with tuberculosis and patients with descriptive diagnosis of serpiginous-like choroiditis (the appearances being atypical for classical acute posterior multifocal placoid pigment epitheliopathy or serpiginous choroiditis) diagnosed between September 2002 and September 2012 were identified from the database of the Manchester Uveitis Clinic. The retinal images were retrieved and reviewed retrospectively. Data were then extracted from the clinical records of included patients, including age, sex, ethnic origin, history of previous tuberculosis or contact with tuberculosis, Mantoux testing and/or interferon γ (QuantiFERON TB Gold) testing result and treatment details. Ocular status including visual acuity on presentation and after treatment, retinal imaging and degree of inflammation were assessed.

Results:

Fourteen patients presented with serpiginous-like choroiditis over 10 years (7 within the last 2 years). Seven of 14 patients showed evidence of exposure to tuberculosis and received anti-tuberculosis treatment. Seventeen of 23 eyes showed stable or improved visual acuity.

Conclusions:

Multifocal outer retinal and inner choroidal inflammation is a marker for intraocular tuberculosis of increasing importance, even in a non-endemic area. Originally described as 'serpiginous-like choroiditis', the lesions are multifocal, irregular in shape, very numerous, widespread, often asymmetrical and demonstrating both active and resolved lesions simultaneously. Active lesions show contiguous extension. We recommend that every patient with serpiginous-like choroiditis should undergo testing for previous exposure to tuberculosis, and undergo anti-tuberculosis treatment if lesions are progressive and sight-threatening.

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