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Mei Zhou, Michael Andreoli, Debra A Goldstein, Yannek Isaac Leiderman, Netan Choudhry; Multimodal imaging of the posterior segment in patients with chorioretinal manifestations of tuberculosis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6169.
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© ARVO (1962-2015); The Authors (2016-present)
Ocular manifestations of tuberculosis are diverse and frequently occur in the absence of active systemic disease or known infection. The purpose of this study was to characterize the posterior segment manifestations of ocular tuberculosis via multimodal ophthalmic imaging.
A multi-center retrospective review of clinical records and imaging data, including fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICG), fundus autoflourescence (FAF), and spectral domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI-OCT), was performed in patients with posterior segment disease presumed secondary to tuberculosis.
36 eyes of 30 patients with posterior segment manifestations of tuberculosis were identified. The mean age at diagnosis was 34 years (range 19 - 62 years) and mean duration of follow-up was 7 months (range 0.5 - 24 months).<br /> <br /> Patients with acute disease exhibited creamy yellow lesions 1 or more disc-diameters in area with indistinct borders, frequently located within the posterior pole. A subset of lesions exhibited interconnected pigmentary alterations of the retinal pigment epithelium in a dendritiform pattern contiguous with the optic nerve. FAF of acute lesions exhibited central hypoautofluorescence with granular hyperautofluorescent margins. Following resolution of acute lesions, FAF revealed predominantly hypoautofluorescence. FA of acute lesions exhibited early hypofluorescence and late hyperfluorescence. ICG revealed areas of hypocyanescence. SD-OCT of active lesions most commonly exhibited punctate and/or diffuse hyperreflective intraretinal foci and diffuse outer-retinal hyperreflectivity. Subacute lesions exhibited attenuation of the outer retina manifest as loss of the normal outer retinal hyperreflective bands and subretinal hyperreflective lesions. EDI-OCT demonstrated hypo- or hyperreflective choroidal foci associated with lesions in the acute and resolution phases.
Multimodal imaging of the retina and choroid in patients with tuberculous posterior uveitis may help monitor disease activity and response to treatment, and may yield additional insights into disease pathophysiology.
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