PCR-positive tubercular retinal vasculitis - Clinical characteristics and management

Background: Inflammation of retinal vessels is a known association of syste mic tuberculosis. Patients with retinal vasculitis are subjected to extensi ve but unrewarding systemic workup. Polymerase chain reaction (PCR) is now commonly used to detect DNA of infective organisms including Mycobacterium tuberculosis. This study was undertaken to characterize the clinical charac teristics of PCR-positive tubercular retinal vasculitis, so as to determine the clinical presentation, associated systemic features, management, and c ourse of this form of vasculitis. Methods: The clinical records of 13 patients seen between 1997 and 1999 wit h the diagnosis of PCR-positive tubercular retinal vasculitis from the aque ous or vitreous humor were reviewed. Recorded data included age, sex, race, visual acuity, anterior and posterior segment findings, and results of dia gnostic evaluations. All received antituberculosis therapy with or without concomitant corticosteroids. Laser scatter photocoagulation was done in eye s with neovascularization. One eye with vitreous hemorrhage was subjected t o pars plana vitrectomy. Results: There were 9 (69.2%) male and 4 (30.7%) female patients with a med ian age of 20 years. The disease was bilateral in seven. The most consisten t finding was the presence of vitritis in all the eyes followed by vitreous snowball opacities in 17 eyes (89.4%), neovascularization in 11 eyes (57.8 %), retinal hemorrhages in 10 eyes (52.6%), neuroretinitis in 10 eyes (52.6 %), focal choroiditis in 9 eyes (47.3%), vitreous/preretinal hemorrhage in 5 eyes (26.3%), and serous retinal detachment in 3 eyes (15.7%). Over a med ian follow-up of 12 months, all showed resolution of vasculitis with no rec urrences. Conclusions: Polymerase chain reaction-positive tubercular retinal vasculit is had varied associated fundus findings. Its recognition is important so a s to order only relevant diagnostic tests.