Comparison of retinal and choroidal involvement in tuberculous chorioretinitis in a non‐endemic area

Purpose To assess the respective involvement of retina versus choroid in presumed ocular tuberculosis (POT) in a non‐endemic area using dual fluorescein (FA) and indocyanine green angiography (ICGA). Methods Retrospective study on patients with the diagnosis of POT seen in the Centre for Ophthalmic Specialized Care, Lausanne, Switzerland. Angiography signs were quantified according to an established FA and ICGA scoring system for uveitis (Int Ophthalmol. 2010;30:539–52 and Ocul Immunol Inflamm 2010;18:385–9). Results Among the 1739 uveitis patients seen from 1995 to 2014, 53 patients were diagnosed as POT (3%) of which 28 had sufficient data to be included in the study. The choroid was predominantly involved in 22 patients and the retina in 6 patients. The mean angiographic score was 6.19/36 ± 4.11 for the retina versus 13.48/36 ± 7.06 for the choroid. For patients having sufficient angiographic follow‐up, the scores decreased from 6.19 to 2.40 ± 2.39 for FA and from 13.48 to 7.87 ± 5.37 for ICGA after combined antituberculous and inflammation suppressive therapy. Conclusions This study shows for the first time the respective involvement of retina and choroid in POT. Choroid is preferentially involved for which ICGA is the examination of choice. By looking only at FA, there is a risk of underestimating global ocular involvement and to miss the diagnosis. To evaluate correctly intraocular inflammation in POT and to have a better follow‐up, the use of dual FA & ICG angiography is recommended. On the other hand, in case of a compatible uveitis having a positive IGRA test, in a non‐endemic area, dual FA & ICGA should be performed to avert or help the diagnosis of ocular tuberculosis.