Clinical and imaging characteristics of neuroretinitis secondary to cat scratch disease from tertiary centers in Malaysia: a retrospective study

Cat scratch disease (CSD) is the commonest etiology of neuroretinitis (NR) and is caused by Bartonella henselae. The objective of this study was to look at clinical, imaging characteristics and outcomes among serology confirmed Cat scratch disease Neuroretinitis (CSD NR). A retrospective review of clinical records of 33 eyes from 28 patients was undertaken over a 5-year period between April 2015 and February 2020. Mean age at presentation was 34.3 years. Twenty-two (78.6%) had contact with cat. Mean duration of ocular symptoms was 7.0 days. Eighteen (64.3%) had history of fever while 24 (85.7%) complained of blurring of vision. Median baseline logMAR visual acuity was 0.8 (0.2-2.00) and median final logMAR VA was 0.2 (0.00-1.8), p < 0.01. Anterior segment inflammation was absent (57.6%) or mild (36.4%). An inflammatory angiomatous optic nerve head lesion was present in 9 (27.3%) eyes. Seventeen (51.5%) eyes had retinal infiltrates or focal retino-choroiditis. This was seen in 66.7% eyes presenting within a week and was absent in 77.8% presenting after a week (p = 0.034). Eight (24.2%) eyes had no macula exudates at presentation out of which 7 had peripapillary subretinal fluid (SRF) on optical coherence tomography (OCT). Median baseline oct central subfoveal thickness (CST) was 303 μm (213–1159) and median final CST was 262 μm (193–344), p < 0.001. Hyperreflective vitreous dots on OCT were present in 16 (50.0%) with no clinical evidence of vitritis or vitreous cells in 18.75%. Peripapillary SRF was seen in 26 (81.3%), subfoveal SRF in 23 (71.9%), macula intraretinal fluid (IRF) in 12 (37.5%) and abnormal foveal contour in 22 (68.8%). Fluorescein angiography showed disc leakage in 10 out of 15 eyes (66.7%). All patients received treatment, 17(60.7%) with oral antibiotics and 11 (39.3%) with additional oral steroids. Presenting visual acuity was moderate to poor with good final visual outcomes. Severe anterior uveitis was uncommon. Absence of baseline macular exudates maybe associated with peripapillary subretinal fluid. Retinal infiltrates or focal retino-choroiditis were common but seen early in presentation. Hyperreflective dots in the vitreous on OCT may precede clinical visualization of vitreous involvement. Significant reduction in CST on OCT was seen at six weeks.