Multifocal choroiditis and choroidal tuberculoma: Signs of presumed ocular tuberculosis.

The diagnosis of OTB (Ocular tuberculosis) is usually difficult to make. Definitive diagnosis requires the identification of M. tuberculosis organisms in ocular tissues or fluids, but samples are often difficult to obtain, and biopsy may be hard to justify. We describe a 50-years-old Maghreb male, who presented a multifocal choroiditis associated with a choroidal tuberculoma on the left eye. Based on positive QuantiFERON-TB-Gold test and suggestive clinical and radiographic findings, a diagnosis of presumed ocular tuberculosis was made. Serial swept-source optical coherence tomography (SS-OCT) and widefield fundus retinographies during subsequent follow-up visits demonstrated the characterization of the atypical tuberculosis presentation and allowed the assessment of response to antitubercular therapy and oral steroids.

The Nature and Frequency of Outer Retinal Disruption in Idiopathic Multifocal Choroiditis Associated With Persistent Fundus Hyperautofluorescence.

BACKGROUND AND OBJECTIVE: To describe the prevalence and anatomic correlates for hyperautofluorescence related to outer retinal disruption in eyes with multifocal choroiditis (MFC). PATIENTS AND METHODS: Retrospective review of MFC patients. RESULTS: Fifty-nine eyes from 37 patients were analyzed. Multimodal imaging was utilized to identify nine eyes (15.2%) of six patients with either transient (Group 1) or persistent (Group 2) regions of hyperautofluorescence associated with ellipsoid zone (EZ) disruption over intact retinal pigment epithelium (RPE). Group 1 included four eyes (6.8%) of three patients in which the hyperautofluorescence and EZ loss resolved within a few months (range: 28 days to 125 days) and had intact overlying outer nuclear (ONL) and outer plexiform layers (OPL) (mean follow-up: 1.3 years). Group 2 included five eyes (8.5%) of three patients with regions of permanent EZ disruption associated with absent or reduced ONL and OPL (mean follow-up: 4.6 years). CONCLUSIONS: Hyperautofluorescence correlating with EZ disruption over intact RPE is a rare occurrence in MFC. Evaluating outer retinal integrity by optical coherence tomography may help identify eyes with potential for EZ restoration, which may have implications regarding treatment strategies. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:675-683.].

OCT Angiography in Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

BACKGROUND AND OBJECTIVE: To describe retinal and choroidal findings in different stages of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). PATIENTS AND METHODS: Retrospective, noncomparative case series studied by fundus biomicroscopy, fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomographic (SD-OCT), and swept-source OCT angiography (SS-OCTA). RESULTS: Six eyes of three patients with bilateral APMPPE were included. FAF showed multifocal, branched patches of hyperautofluorescence with areas of hypoautofluorescence; FA disclosed early hypofluorescence, with late-phase hyperfluorescence; ICGA showed early and late-phase hypofluorescence. SD-OCT imaging revealed bilateral retinal thinning, external limiting membrane (ELM) disruption, and severe alteration of the photoreceptor-retinal pigment epithelium complex. SS-OCTA showed widespread multiple dark spots in the choriocapillaris in Cases 1 and 2. Rarefaction and voids in the vascular texture were also detected in the deep plexus, unlike in Case 3, where the lesions were smaller and earlier, suggesting that retina vasculature may be affected after the choriocapillaris obstruction. CONCLUSIONS: APMPPE may result from a distinct focal ischemia in the choriocapillaris, and OCTA allowed the authors to localize exactly all the placoid lesions and monitor the areas of absent fluid signal. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:428-436.].

Enhanced Depth Imaging by High-Resolution Spectral Domain Optical Coherence Tomography in Tubercular Multifocal Serpiginoid Choroiditis.

Purpose: To report the choroidal changes by enhanced depth imaging optical coherence tomography (EDI-OCT) in tubercular multifocal serpiginoid choroiditis (MSC). Methods: Prospective study of 20 patients (23 eyes) with active MSC who underwent simultaneous fundus autofluorescence and EDI-OCT imaging at regular visits. Results: Eyes with acute lesions demonstrated diffuse choroidal thickening at presentation, which decreased significantly as the lesions healed. Additionally, the region of (thickened) choroid just beneath the active choroiditis lesion demonstrated a localized area of mixed reflectivity (a central hyperreflectivity surrounded by a zone of hyporeflectivity), suggesting choroidal involvement deeper to choriocapillaris. Once the lesions healed, the choroid under the scar showed a localized thinning, along with outer retinal layers loss. Conclusion: EDI-OCT highlighted diffuse and localized choroidal structural changes in MSC as the lesions evolved from acute to healed stage, providing an adjunct to clinical examination for monitoring response to therapy.