Late Diagnostic Revision to Tubercular Choroiditis in Patients with Recurrent APMPPE: A Retrospective Study in 28 Cases.

PURPOSE: To investigate recurrence patterns of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and its diagnostic revision to ocular tuberculosis (TB).

METHODS

Retrospective review of electronic medical records from 2014 to 2024 at two tertiary eye care centers in East and South India, respectively, of patients diagnosed with APMPPE, and with a follow-up of ≥3 months.

RESULTS

We identified 28 cases of APMPPE from the two centres during the study period, all of whom responded to the initial treatment with oral corticosteroids. The diagnosis was based on lesion morphology, and none were investigated for TB at baseline. Six (21.4%) of these cases experienced recurrent inflammation. Among these, one patient retained the original diagnosis of APMPPE and was treated again with corticosteroids. However, five were reclassified as ocular TB based on lesion morphology (four as choroidal granuloma and one as serpiginous-like choroiditis) and positive TB tests, and all resolved with a combination of anti-TB therapy (ATT) with or without corticosteroids. Except for one, no recurrences were observed after ATT, with a median follow-up of 128.5 months (range 5.5-227 months).

CONCLUSION

APMPPE might be the first sign of ocular TB, particularly in recurrent cases. All APMPPE cases should be carefully monitored and investigated for TB on recurrence, even after initial response to corticosteroid therapy.