This study included 14 eyes of 9 patients (5 men) with Tb-SLC and 12 eyes of 8 patients (5 men) with SC. All patients were followed from the acute disease stage through final healing. The mean patient age was 44.0 ± 7.4 years (range: 26-58 years) in patients with Tb-SLC and 54.6 ± 9.8 years (range: 46-66 years) in patients with SC (P = 0.03). Demographic and clinical characteristics of included patients are summarized in Table 1.
Group Males Females Eyes Bilateral Age (years) BCVA LogMAR BCVA Lesion Location SC 6 2 12 6.00 54.6 ± 9.8 0.3 0.52 9 disc, 3 macula centered Tb-SLC 5 4 14 6.00 44.0 ± 7.4 0.1 1.00 2 disc, 12 macula centered P 0.40 0.71 0.03 < 0.01 < 0.01 Note. SC: serpiginous choroiditis; Tb-SLC: tuberculous serpiginous-like choroiditis; BCVA: best corrected visual acuity.
Table 1. Clinical Features of Serpiginous Choroiditis and Tuberculous Serpiginous-like Choroiditis
The following eight OCT findings were most commonly observed in our study patients: (1) vitreal irregular, spheroid hyper-reflective spots (discrete, > 20 µm), (2) outer nuclear layer (ONL) hyper- reflection (small or punctiform hyper-reflective spots within the ONL), (3) intraretinal edema (retinal swelling, inner nuclear layer and outer plexiform layer cystoid cavities), (4) hyporeflective, wedge-shaped band within the outer plexiform layer, (5) outer retinal tubulation (round or ovoid hypo-reflective spaces with hyper-reflective borders in the ONL) of the retina), (6) sub-RPE conical, drusenoid deposits (sub-RPE deposition of drusenoid materials with a conical appearance), (7) choriocapillaris point-like hyper-reflections, (point-like hyperreflection appeared within choriocapillaris); and (8) choroidal granulomas (round or lobulated choroidal lesions on EDI-OCT scans, FA, and ICGA as hypofluorescence changes); Table 2, Figures 2-4).
No. Total Eyes SC (n = 12) Tb-SLC (n = 14) PValue 1 Vitreal hyper-reflective spots 0 5 0.02 2 Outer nuclear layer hyper-reflection 12 13 0.35 3 Intraretinal edema 3 11 0.01 4 Hyporeflective, wedge-shaped band 9 5 < 0.05 5 Outer retinal tabulation 4 7 0.40 6 Sub-RPE drusenoid deposits 2 11 < 0.01 7 Choriocapillaris point-like hyper-reflection 10 13 0.45 8 Choroidal granulomas 2 8 0.03 Note. SC: serpiginous choroiditidis; Tb-SLC: tuberculous serpiginous-like choroiditis; RPE: retinal pigment epithelium.
Table 2. Frequency of Optical Coherence Tomography Signs in Patients with Serpiginous Choroiditidis and Tuberculous Serpiginous-like Choroiditis
Figure 2. (A) Optical coherence tomography scans passing through active lesion edges show outer nuclear layer thinning and Henle fiber layer hyper-reflection. The underlying ellipsoid zone and RPE remained relatively intact (boxes). (B) Optical coherence tomography scans of a 49-year-old patient with tuberculous serpiginous-like choroiditis. Discrete vitreal hyper-reflective spots (arrows) are visible. Intraretinal edema (arrow heads), elevated sub-RPE drusenoid deposits (square), and choriocapillaris point-like, hyper-reflective lesions (circle) are also apparent. (C) Optical coherence tomography scans of a 47-year-old patient with serpiginous choroiditis. Optical coherence tomography scans show an intraretinal, wedge-shaped hyporeflection (arrow heads). No vitreal hyper-reflective spots or elevated sub-RPE drusenoid deposits were observed. (D) Optical coherence tomography scans of a 62-year-old patient with serpiginous choroiditis. No vitreal hyper-reflective spots are visible. Outer retinal tubulation and choroidal atrophy are also visible within a relatively stable lesion (arrowheads).
Figure 3. Ocular images of a 35-year-old patient with tuberculous serpiginous-like choroiditis. (A) A color fundus photograph shows grayish-yellow active lesions superior to the disc (arrowhead). (B) A fundus autofluorescence (FAF) image showing diffuse hyperautofluorescence in the same location as the active lesion. (C) An optical coherence tomography scan showing a hyper-reflective lesion (arrow head) corresponding to fundus photograph and FAF image anomalies. The entire retina and the preretinal vitreous cortex (arrow) are involved.
Figure 4. Images of a 47-year-old patient with tuberculous serpiginous-like choroiditis. (A, B) Optical coherence tomography scans reveal the presence of choroidal granulomas (arrow heads) beneath active lesions. (C) A color fundus photograph showing grayish-yellow active lesions that correspond to granuloma locations. (D, E) Fundus fluorescein and indocyanine green angiography images show hypofluorescent regions corresponding to lesion locations.
The frequency of each OCT sign in patients with SC and Tb-SLC is summarized and compared in Table 2. Some OCT signs were commonly detected in both SC and Tb-SLC eyes, including ONL hyper-reflections [13 Tb-SLC eyes (93%), 12 SC eyes (100%); P = 0.35], choriocapillaris point-like hyper-reflections [13 Tb-SLC eyes (93%), 10 SC eyes (83%); P = 0.45], and outer retinal tubulation [7 Tb-SLC eyes (50%), 4 SC eyes (33%), P = 0.40]. However, some OCT signs were observed significantly more often in patients with Tb-SLC than with SC. These included vitreal hyper-reflective spots [5 Tb-SLC eyes (36%), 0 SC eyes (0%); P = 0.02], intraretinal edema [11 Tb-SLC eyes (79%), 3 SC eyes (25%); P = 0.01], sub-RPE drusenoid deposits [11 Tb-SLC eyes (79%), 2 SC eyes (17%); P < 0.01], and choroidal granulomas [8 Tb-SLC eyes (57%), 2 SC eyes (17%); P = 0.03]. In contrast, a hyporeflective, wedge-shaped band was observed more often in eyes with SC than Tb-SLC [5 Tb-SLC eyes (36%), 9 SC eyes (75%); P < 0.05].