Aniruddha Agarwal1, Kanika Aggarwal2, Francesco Pichi3, Tian Meng4, Marion R Munk4, Krinjeela Bazgain2, Reema Bansal2, Rupesh Agrawal5, Vishali Gupta2. 1. Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India. Electronic address: aniruddha9@gmail.com. 2. Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India. 3. Eye Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA. 4. Department of Ophthalmology, Inselspital, University Hospital, University of Bern, Bern, Switzerland. 5. National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Singapore Eye Research Institute, Singapore; Moorfields Eye Hospital, NHS Foundation Trust, London, UK; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Duke NUS Medical School, Singapore; Yong Loo Linn School of Medicine, National University of Singapore, Singapore; School of Material Science and Engineering, Nanyang Technological University, Singapore.
Abstract
PURPOSE: To compare the differences among clinical, demographic, and multimodal imaging features of choroidal granulomas associated with tuberculosis and sarcoidosis. DESIGN: Retrospective comparative case series. METHODS: Clinical features and fundus imaging, including fluorescein and indocyanine green angiography and optical coherence tomography of patients with tuberculomas and sarcoid choroidal granulomas seen at 3 tertiary care centers, were reviewed. The differences among clinical appearances, including morphology of the lesions (size, shape, extent), vascularity, and multimodal imaging features, were compared. Repeated logistic regression measurements with a multilevel random effects model was used to assess characteristics of individual granulomas that could predict the underlying cause. RESULTS: The study included 47 eyes of 38 patients (22 with tuberculomas and 16 with sarcoid granulomas; total of 138 granulomas). Patients with tuberculomas were significantly younger (33.8 ± 10.1 vs. 48.6 ± 14.3 years, respectively; P = .002), but no sex differences were observed. In comparison with sarcoid granulomas, tuberculomas were solitary (P <.001), intense yellow, lobulated, full thickness, and located in the perivascular region (all P <.001); they were also larger (16.01 ± 9.7 mm2 vs. 2.7 ± 4.5 mm2, respectively; P <.001) and were vascularized (P <.001). Sarcoid granulomas were associated with retinal vasculitis (P = .003) and disc hyperfluorescence (P <.001). Logistic regression showed that multiple granulomas were associated with sarcoidosis (odds ratio [OR]: 3.5; 95% confidence interval: 1.8-6.9; P <.001). Granulomas larger than 6.45 mm2 had the highest area under the receiver operating curves (0.94) for differentiating tuberculomas from sarcoid granulomas. CONCLUSIONS: Tuberculomas and sarcoid choroidal granulomas have various clinical and imaging features that help differentiate between the 2 entities with high predictability and can supplement immunological and radiological tests in a diagnosis.
PURPOSE: To compare the differences among clinical, demographic, and multimodal imaging features of choroidal granulomas associated with tuberculosis and sarcoidosis. DESIGN: Retrospective comparative case series. METHODS: Clinical features and fundus imaging, including fluorescein and indocyanine green angiography and optical coherence tomography of patients with tuberculomas and sarcoid choroidal granulomas seen at 3 tertiary care centers, were reviewed. The differences among clinical appearances, including morphology of the lesions (size, shape, extent), vascularity, and multimodal imaging features, were compared. Repeated logistic regression measurements with a multilevel random effects model was used to assess characteristics of individual granulomas that could predict the underlying cause. RESULTS: The study included 47 eyes of 38 patients (22 with tuberculomas and 16 with sarcoid granulomas; total of 138 granulomas). Patients with tuberculomas were significantly younger (33.8 ± 10.1 vs. 48.6 ± 14.3 years, respectively; P = .002), but no sex differences were observed. In comparison with sarcoid granulomas, tuberculomas were solitary (P <.001), intense yellow, lobulated, full thickness, and located in the perivascular region (all P <.001); they were also larger (16.01 ± 9.7 mm2 vs. 2.7 ± 4.5 mm2, respectively; P <.001) and were vascularized (P <.001). Sarcoid granulomas were associated with retinal vasculitis (P = .003) and disc hyperfluorescence (P <.001). Logistic regression showed that multiple granulomas were associated with sarcoidosis (odds ratio [OR]: 3.5; 95% confidence interval: 1.8-6.9; P <.001). Granulomas larger than 6.45 mm2 had the highest area under the receiver operating curves (0.94) for differentiating tuberculomas from sarcoid granulomas. CONCLUSIONS:Tuberculomas and sarcoid choroidal granulomas have various clinical and imaging features that help differentiate between the 2 entities with high predictability and can supplement immunological and radiological tests in a diagnosis.