RETINAL OCCLUSIVE VASCULITIS SECONDARY TO TUBERCULOSIS – A CLINICAL REPORT

Abstract

Purpose: To report the case of a patient with persistent right eye (RE) hemovitreous secondary to occlusive retinal vasculitis secondary to tuberculosis. Methods: Male patient, 35 years old, Indian descent, with no history of previous systemic illness. First presented to our outpatient clinic with decreased visual acuity RE with 8 months duration. On exam, BCVA RE: <5/200 and BCVA LE: 20/20; keratic precipitates were visible and anterior chamber flare was described as 1+; extensive RE hemovitreous were present precluding fundus observation. A fluorescein angiography (FA) performed on his LE was normal. He was started on topical steroids and submitted to pars plana vitrectomy + intra-operative retinal photocoagulation on his RE for peripheral retinal neovascularization. Results: Post-surgery exam, BCVA RE: 20/100 and BCVA LE: 20/20, no anterior chamber reaction bilaterally. RE macular edema with exuberant vascular turtuosity and “ghost vessels”. FA confirmed active occlusive vasculitis on RE. Diagnostic work-up was positive for a 28 mm induration tuberculin test, supporting the diagnosis of ocular tuberculosis. The patient was started on anti-tuberculous medication. Three months later, BCVA RE was 20/25 with no anterior chamber reaction OU. Eighteen months on, the patient maintains good bilateral visual acuity without any evidence of disease reactivation. Conclusions: In the clinical case described there was a good response after antituberculosis treatment instituted unassociated oral corticosteroid therapy, with improved visual acuity and remission of inflammatory angiographic signs, stressing the importance of tuberculous etiology research in cases of retinal vasculitis.