Beyond Neuroretinitis: A Multi-Centre Study of Bartonella-Associated Uveitis

Abstract

Purpose To characterise the spectrum of clinical presentations of Bartonella-associated uveitis across multiple tertiary uveitis centres and assess the frequency of non-neuroretinitis phenotypes.Methods Multi-centre retrospective case series of patients with serologically confirmed Bartonella infection and associated intraocular inflammation. Clinical phenotypes were classified as classical (isolated neuroretinitis) or non-neuroretinitis based on anatomic and multimodal imaging findings, and their relative frequencies were analysed.Results Seventy eyes of 53 patients were included. Median presenting best-corrected visual acuity was 20/50 (IQR 20/20 to 20/400). Posterior uveitis (57.1%) and panuveitis (30.0%) were the most frequent anatomical classifications. Neuroretinitis was present in 35 (50.0%) eyes. Non-classical manifestations were common and included optic neuritis (34.3%), multifocal retinitis (30.0%), isolated papillitis (24.3%), retinal vascular occlusion (18.6%), and multifocal choroiditis (11.4%).Conclusion Non-neuroretinitis manifestations of Bartonella-associated uveitis comprise a substantial proportion of presentations in tertiary uveitis practice. Although these phenotypes have been individually described previously, our findings emphasise that Bartonella infection should remain an important differential diagnosis across a broad spectrum of posterior segment inflammatory presentations rather than being considered predominantly a cause of neuroretinitis.