Tubercular retinal vasculitis

Abstract

Intraocular tuberculosis (TB) infection can have different clinical manifestations including retinal vasculitis. It more frequently involves the veins and is associated with retina haemorrhages and neovascularisation. The diagnosis may be difficult and presumptive being based on clinical findings and evidence of systemic TB infection. The authors present a case of a 61-year-old woman with blurred vision and floaters in her left eye for 6 years, associated with recurrent vitreous haemorrahages. A temporal branch retinal vein occlusion was presumed. Four years later her right eye was also involved. Her best-corrected visual acuity (BCVA) was 20/50 in both eyes. Fundoscopic examination showed bilateral venous occlusion with vascular staining on fluorescein angiography suggestive of vasculitis secondary to Eales Disease (ED). The interferon gamma release assay (IGRA-QuantiFERON-TB Gold) was positive and antituberculosis treatment (ATT) was started. Her final BCVA was 20/20 bilaterally, without recurrences over a follow-up of 15 months. The use of ATT is likely to reduce recurrent vitreous haemorrhages and eliminate future recurrences.

Figure 1

Ocular fundus of the right eye with intraretinal haemorrhages and of the left eye showing vascular sheathing, neovascularisation and capillary non-perfusion.

Figure 2

Fluorescein angiography showing capillary non-perfusion, vascular sheathing and neovascularisation with late leakage and chorioretinal scars secondary to the laser treatment.

Figure 3

Ocular fundus after antituberculosis treatmenttreatment without vitreous haemorrhage.