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Abstract
Purpose
The purpose of this study is to make a distinction between tuberculous serpiginous-like choroiditis and serpiginous choroiditis, and compare their clinical manifestations.
Methods
We retrospectively reviewed thirty eight eyes of twenty-six patients who visited our institution and were diagnosed with serpiginous choroiditis from January 2005 to December 2014. The patients were divided into two groups, tuberculosis serpigi-nous-like choroiditis (Tb-SLC) and classic serpiginous choroiditis (classic SC), and were analyzed based on the treatment re-sponse, previous history of Bacillus Calmette– Guérin (BCG) vaccination, positive results of tuberculin skin test (TST), chest X-ray, anterior and fundus examination, and fluorescein angiography (FAG).
Results
Twenty seven eyes of eighteen patients were serpiginous choroiditis and eleven eyes of eight patients were tuber-culosis serpiginous-like choroiditis. There were no significant differences in age, sex, or previous history of BCG vaccination be-tween the two groups. The positive result of the tuberculin skin test and abnormality in the chest X-ray were shown to be sig-nificantly higher in the Tb-SLC group. Multi-focal lesions involving periphery observed in fundus examination and FAG were sig-nificantly higher in Tb-SLC.
Conclusions
In tuberculosis endemic areas such as Korea, tuberculosis serpiginous-like choroiditis should be considered as a differential diagnosis when the patient is suspicious of serpiginous choroiditis. The understanding of various clinical manifes-tations of tuberculosis serpiginous-like choroiditis may derive accurate diagnosis and treatment, enhancing patient’s prognosis. J Korean Ophthalmol Soc 2017;58(1):50-55
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Table 1.
Demographic characteristics of the patients
| Tb-SLC (n = 8) | Classic SC (n = 18) | p-value | |
|---|---|---|---|
| Sex (male:female) | 6:2 | 12:6 | 0.524* |
| Age (years) | 68.6 ± 11.0 | 66.3 ± 8.9 | 0.490† |
| Previous tuberculosis history (n, %) | 8 (100) | 4 (22) | <0.010* |
| Normal chest X-ray (n, %) | 0 (0) | 14 (78) | <0.010* |
| BCG vaccination (n, %) | 6 (75) | 14 (78) | 0.622* |
| TST positive (n, %) | 8 (100) | 0 (0) | <0.010* |
Table 2.
Comparison of clinical symptoms and signs between Tb-SLC and Classic SC
| Tb-SLC (n = 11) | Classic SC (n = 27) | p-value* | |
|---|---|---|---|
| Decreased visual acuity | 7 (64) | 18 (67) | 1.000 |
| Metamorphosia | 3 (27) | 7 (26) | 0.134 |
| Floater | 1 (9) | 2 (7) | 0.395 |
| Recovered visual acuity | 3 (27) | 7 (26) | 0.615 |
| Continuous with optic disc | 2 (18) | 22 (82) | <0.010 |
| Involvement of macula | 5 (45) | 20 (74) | 0.135 |
| Involvement of periphery | 11 (100) | 2 (7) | <0.010 |
| Multifocal lesions | 10 (91) | 4 (15) | <0.010 |
| Anterior segment inflammation | 5 (45) | 5 (19) | 0.116 |
| Posterior segment inflammation | 8 (73) | 10 (37 ) | 0.074 |
Figure 1.
Indocyanine green angiography (ICGA) and fluorescein angiography (FAG) of the patients. ICGA and FAG of tuber-culosis serpiginous-like choroiditis showing wide spread multifocal lesions (A, B), ICGA and FAG of serpiginous choroiditis show-ing large solitary lesion that extends from the juxta-papillary area (C, D).
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