Optic Nerve Head Tubercular Granuloma Successfully Treated with Anti-VEGF Intravitreal Injections in Addition to Systemic Therapy

Author:

Invernizzi Alessandro12,Franzetti Fabio3,Viola Francesco2,Meroni Luca3,Staurenghi Giovanni1

Affiliation:

1. Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy

2. Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-CÀ Granda Foundation–Ospedale Maggiore Policlinico, Milan - Italy

3. Department of Clinical Sciences, Luigi Sacco Hospital, Section of Infectious and Tropical Diseases, University of Milan, Milan - Italy

Abstract

Purpose To describe a case of optic nerve head tubercular granuloma, unresponsive to conventional therapy (antitubercular drugs and systemic steroids), successfully treated with anti–vascular endothelial growth factor (VEGF) intravitreal injections in addition to systemic drugs. Methods Case report. Results A 44-year-old patient was referred to our clinic for progressive vision decrease in his left eye during the preceding 4 months. A large granuloma infiltrating optic nerve head was visible at funduscopic examination along with diffuse intraocular inflammation. Workup for granulomatous uveitis supported the diagnosis of presumed intraocular tuberculosis. However, the large granulomatous lesion did not show a good response to conventional therapy for tubercular uveitis (antitubercular drugs and systemic steroids). Anti-VEGF (bevacizumab) intravitreal injections were performed as an adjunct to the ongoing therapy. After 2 injections, the patient showed an almost complete regression of the lesion (demonstrated by optical coherence tomography) and a restoration of vision. Conclusions Anti-VEGF intravitreal injections should be considered in the treatment of large tubercular granulomatous lesions in addition to conventional systemic therapy. Optical coherence tomography could be a suitable tool for studying and following optic nerve head granulomas.

Publisher

SAGE Publications

Subject

Ophthalmology,General Medicine

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