Concurrent tuberculous chorioretinitis with choroidal neovas
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Tuberculosis (TB) remains a severe health burden worldwide. The manifestation of concurrent tuberculous cerebral and ocular involvements associated with TB is uncommon.

A 17-year-old female patient complained of blurred vision in her right eye (OD) for 4months. Medical history revealed that the patient presented with intermittent low fever, cough for 4months and headache for 4days. Physical examination revealed neck stiffness and bilaterally diminished breath sounds, with a temperature of 37.8°C. On examination, visual acuity in the right eye (OD) was hand motion at 10cm, and visual acuity in the left eye (OS) was normal. The intraocular pressure was 18mmHg in the right eye and 16mmHg in the left eye.

Chest CT showed miliary nodules in the lung.In the right eye, optical coherence tomography (OCT) revealed chorioretinal elevation of macular area, with an area of exudative retinal neurepithelium layer detachment (subretinal fluid sonolucent height was 2.242mm). Ocular ultrasonography B-scan revealed an oval solid mass measuring 6.86mm×2.83mm in the posterior wall of the right eye.

Her systemic condition gradually improved during the first 10days of combination therapy. Cerebral pressure gradually returned to normal from 240 mmH2O, CSF protein concentration decreased, and CSF glucose and chloride returned to normal levels, supporting the diagnosis of tuberculous meningitis. However, the combination therapy did not improve macular edema in the right eye. Then, the patient received an anti-VEGF ranibizumab (0.05mL) injection in the right eye. One month later, OCT scan showed clear retinal structure with a significant improvement of macular edema and disappearance of subretinal fluid. The final visual acuity was 0.2 in the right eye and 1.0 in the left eye.

Systemic anti-tuberculosis medications and corticosteroid therapy frequently result in unsatisfactory optical response, and concomitant intravitreal anti-VEGF injection is an optimal strategy for tuberculous chorioretinitis with CNV.

Source: https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01504-y



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