620 Surv Ophthalmol 49 (6) November–December 2004 LETTERS An aqueous tap was done on all patients and showed PCR positive for tubercle bacilli in one case and smear positive in four cases. FNAB of the mass lesion showed acid-fast bacilli in only two out of four cases for which it was done. We had to resort to choroidal biopsy to confirm the diagnosis in two cases. The biopsy specimens showed tubercle bacilli in one case and PCR positivity for tubercle bacilli in the other. Vitreous specimen obtained through vitrec- tomy in two out of eight cases did not show acid-fast bacilli. B-scan ultrasound showed mass lesions with high surface reflectivity and medium to low internal reflectivity. It was difficult to distinguish these lesions from choroidal excavation. All patients were treated with a multi-drug regimen for tuberculosis. Five patients showed regression of lesions with preservation of vision. Two patients had to undergo evisceration due to uncontrolled infec- tion. One eye was saved but had no useful vision, due to macular scarring caused by the granuloma. Ocular tuberculosis often mimics and ocular malig- nancy. In cases with no positive history of systemic tuberculosis, the following clues may aid in diagnosis: • High index of suspicion in cases presenting from countries that are endemic for tuberculosis • A melanoma-like mass at a young age • Rapid growth of the mass or a sudden change in color • Variable color of the lesion • Presence of increasing levels of intraocular in- flammation that is not commensurate with a true intraocular malignancy Dr.Mahesh P. Shanmugam Dr. M.Nandakumar Chennai, India doi:10.1016/j.survophthal.2004.08.013 Author’s Response: We would like to thank our colleagues from Chennai, India, for their interest and sharing their experience with us. We agree with their comments. We have ben- efited from their extensive experience with ocular tuberculosis. Hakan Demirci, MD Carol L. Shields, MD Jerry A. Shields, MD Philadelphia, Pennsylvania, USA doi:10.1016/j.survophthal.2004.08.014 Polypoidal Choroidal Vasculopathy To the Editor: We read with great interest Dr Ciardella et al’s article, “Polypoidal Choroidal Vasculopathy” (Surv Ophthalmol 49:357–37, 2004). The article was very well written and covered every aspect of this re- cently recognized entity. To the best of our knowledge, there has been no report of this disease from the Indian subcontinent. We wish to report that polypoidal choroidal vasculo- pathy (PCV) does occur in the Indian population as well and share our experiences with this disease in the Indian population by this letter. At a tertiary center in south India we have so far seen 34 patients (53 eyes) with this disease over a 2-year period. Our experience with this disease has been quite the same as reported by Kowk et al 2 in the Chinese population in terms of age group, presenting features, and angio- graphic behavior. In our study, only 34 (7.5%) out of 450 patients who had indocyanine green angiography (ICGA) performed with a provisional diagnosis of age-related macular degeneration were found to have PCV. In a similar retrospective study of elderly Caucasians in Italy, 7 the frequency reported was 9.8%, whereas in the Chinese study it was reported to be 9.3%. 2 The mean age at presentation in our series was 58.76 (range 43–82) years. The most common clinical fea- ture was the presence of single or multiple orange subretinal nodule (69.2%). This was followed by reti- nal pigment epithelium alterations (53.8%), hemor- rhagic pigment epithelial detachment (51.29%), subretinal hemorrhage (51.2%), and retinal exuda- tion (51.2%). Although PCV was thought to be a bilateral peri- papillary disease in the early study by Yannuzzi, 11 studies by Uyama et al, 10 Scassellati-Sforzolinia et al, 7 and Kwok et al 2 showed the rate of bilaterality to be very low. In the Indian patients studies by us, male predominance (56%), bilateral (56%), and macular location of polyps (76.9%) was seen. The polyps in Indian patients appear to be smaller and are seen within clusters more often. Ours as well as other series suggest a macular predominance of the location of polyps. 1–3,7,10 We did not find any correlation of PCV with any systemic disease as noted by Smith et al 8 and Lip et al. 4 Of the 53 eyes, 23 were treated. Eleven patients un- derwent laser to the polyps; 10 of these eyes either maintained or had improvement in visual acuity. Transpupillary thermotherapy was performed in 7 eyes, combination of transpupillary thermotherapy and laser in 2 eyes, and photodynamic therapy in 3 eyes. Three eyes of two patients in our group under- went photodynamic therapy with improvement in