Intravitreal aflibercept for the treatment of a large choroidal tuberculoma: a case report
Purpose
To report a case of a large choroidal tuberculoma, unresponsive to antitubercular therapy (ATT) and systemic corticosteroids, successfully treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections.
Methods
A retrospective review of records from a patient with tubercular uveitis was performed.
Results
An 11-year-old girl presented to ophthalmological evaluation with bilateral ocular pain and red-eye with one month duration. Her best-corrected visual acuity (BCVA) was 20/32 in the right eye (RE) and 20/63 in the left eye (LE). Biomicroscopy revealed bilateral anterior uveitis with iris nodules and fundoscopy showed dense vitritis in both eyes. A complete systemic work-up was performed, with a positive interferon-γ release assay and features suggestive of tuberculosis on chest computed tomography scans. ATT and systemic corticosteroids were started, with progressive resolution of the ocular inflammation. As vitritis cleared, a large macular choroidal tuberculoma with associated subretinal fluid was noted in LE fundoscopy and confirmed by optical coherence tomography. Since the lesion was non-responsive to conventional treatment for tubercular uveitis, intravitreal anti-VEGF injections were started as an adjuvant therapy. The child received two intravitreal injections of aflibercept, with complete regression of the choroidal tuberculoma and resolution of the subretinal fluid. At 6-months follow-up, BCVA was 20/25 in both eyes with no recurrence of the disease.
Conclusion
Despite seldomly described in literature, intravitreal anti-VEGF therapy may have a role in the treatment of large choroidal tuberculomas with weak response to conventional therapy.
Conflict of interest
No
Authors 1
Last name
FERREIRA
Initials of first name(s)
C.
Department
Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho
City
Vila Nova de Gaia
Country
Portugal
Authors 2
Last name
MARTINS
Initials of first name(s)
P.
Department
Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho
City
Vila Nova de Gaia
Country
Portugal
Authors 3
Last name
FONSECA
Initials of first name(s)
S.
Department
Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho
City
Vila Nova de Gaia
Country
Portugal
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