Yellow Sub-Retinal Pigment Epithelium (YSRPE) Deposits: A Novel Sign in Ocular Tuberculosis

Purpose: To describe a novel clinical and imaging finding in patients with tubercular posterior uveitis. Methods: A retrospective review of 3 cases presented at a tertiary referral eye centre in North India between June 2016 to March 2019 was performed. All the patients had received an initial diagnosis of non-infective etiologies (sympathetic ophthalmia, necrotizing scleritis and lymphoma). Fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), and enhanced-depth imaging optical coherence tomography (EDI-OCT) were reviewed. Results: Three patients (all Asian Indian females: aged 18, 49 and 52 years) diagnosed with panuveitis were investigated for various etiologies based on the initial clinical suspicion. During the course of therapy, all the patients developed peripheral yellow sub-retinal pigment epithelim (RPE) deposits (YSRPE) which appeared hypo-autofluorescent on FAF, and initially hypofluorescent with late hyperfluorescence on FA. The patients were subjected to detailed systemic evaluation and laboratory tests. All the patients showed acid fast bacilli on invasive tissue biopsies. After initiation of anti-tubercular therapy, the lesions resolved in all eyes. Conclusions: YSRPE deposits represent a novel and important diagnostic sign of tubercular posterior uveitis.