Purpose

Perivascular chorio-retinal scars (PCRS) in retinal vasculitis have been associated with tuberculosis. We report PCRS in non-tubercular uveitic entities.

Methods

Case records of patients with PCRS seen in past 4 years were reviewed and cases with more than 1 year of follow-up in which tubercular etiology was ruled based on mantoux, quantiferon, treatment response and follow-up collectively were isolated. Etiological diagnosis, investigations, clinical findings, and treatment outcomes were studied.

Results

Out of 50 cases of PCRS, 14 eyes of 8 patients (16%) were diagnosed as non-tubercular uveitis: HSV (n=1), sympathetic ophthalmia (n=1), sarcoidosis (n=1), toxoplasmosis (n=1) and idiopathic (n=4). In 3 cases the scar morphology was different than that of reported for tubercular vasculitis. Mantoux (n=7) was positive in 3 cases, quantiferon TB gold (n= 4) was positive in 1 case. Aqueous tap was positive for HSV in 1. One patient was diagnosed as central nervous system vasculitis. Vaculitis was occlusive in all except 3. None of the eyes had vitreous haemorrhage and 3 eyes had macular edema. Only 1 patient was initially treated with anti-tubercular therapy (ATT). Six patients received immunomodulatory therapy and other 2 were treated with anti-viral and anti-toxoplasma medications along with oral steroids. Median follow-up was 4.75 years (range 1- 10 years). Mean presenting and final corrected distant visual acuity was 20/32 (range: 20/20 – 20/20000) and 20/25 (range: 20/20 – 20/20000) respectively.

Conclusions

Perivascular scars can be seen in non-tubercular posterior uveitis. Detailed investigations, treatment response assessment with adequate follow-up may rule out tubercular etiology and prevent unnecessary ATT.