Ultra-Wide Field Imaging in Paradoxical Worsening of Tubercular Multifocal Serpiginoid Choroiditis after the Initiation of Anti-Tubercular Therapy

Ocul Immunol Inflamm. 2019;27(3):365-370. doi: 10.1080/09273948.2017.1373829. Epub 2017 Oct 11.


Purpose: To evaluate role of ultra-wide field (UWF) versus conventional imaging in the follow-up and paradoxical worsening (PW) of tubercular (TB) multifocal serpiginoid choroiditis (MSC). Methods: Prospective observational study of patients with TB MSC undergoing UWF imaging, autofluorescence and fluorescein angiography was performed. A circle simulating central 75° field representing conventional imaging was drawn on UWF images. The information yielded by the two modalities, progression of choroiditis lesions and PW was compared. Results: 44 eyes (29 patients, mean age: 30.7 ± 9 years; 23 males) were included. UWF imaging showed additional lesions in 39/44 eyes (88.6%). Overall, 16/44 eyes (36.4%) showed PW; 3/16 eyes (18.7%) showed only peripheral PW, while 10/16 eyes showed both central and peripheral PW. Management was altered in 11 patients (37.93%) based on UWF imaging. Conclusions: UWF is more useful than conventional imaging in identifying additional choroiditis lesions, PW and altering the course of therapy in TB MSC.

Keywords: Intraocular tuberculosis; TB; multifocal serpiginoid choroiditis; paradoxical worsening; serpiginous choroiditis; ultra-wide field imaging.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Antitubercular Agents / adverse effects*
  • Antitubercular Agents / therapeutic use
  • Choroid / pathology*
  • Disease Progression
  • Eye Infections, Bacterial / complications*
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy
  • Female
  • Fluorescein Angiography / methods*
  • Follow-Up Studies
  • Fundus Oculi
  • Humans
  • Male
  • Middle Aged
  • Multifocal Choroiditis / diagnosis*
  • Multifocal Choroiditis / etiology
  • Prospective Studies
  • Severity of Illness Index
  • Tomography, Optical Coherence / methods*
  • Tuberculosis, Ocular / complications*
  • Tuberculosis, Ocular / diagnosis
  • Tuberculosis, Ocular / drug therapy
  • Young Adult


  • Antitubercular Agents