To report a case of definitive ocular tuberculosis in a young man

A 24-year -old man presented with decreased vision of the right eye. Complete ophthalmologic examinations and retinal imaging were performed.

Best corrected visual acuity (BCVA) were 6/10 and 2/10 in the right and left eye, respectively. Ocular examination revealed bilateral vitritis, retinal vasculitis, peri-papillary subreinal fibrosis , multiple chorioreinal scar and macular scar . Optical coherence tomography (OCT), fluorescein and indocyanine angiography (FAG/ICG) disclosed juxtafoveal choroidal neovascularization (CNV) in the right eye and retinal vasculitis in both eyes. Review of the patient’s history was unremarkable for any systemic disease and medication. All of the laboratory tests were inconclusive except for PPD test, with 25 mm reaction. With diagnosis of inflammatory CNV due to presumed ocular TB, vitreous biopsy for polymerase chain reaction (PCR) and intravitreal injection of bevacizumab + triamhexal (IVB+IVTA) were performed. Systemic evaluation was negative for systemic TB. Tuberculosis DNA was found in PCR .With diagnosis of ocular TB, the patient was started on standard anti-TB treatment. One month after intravitreal injection, BCVA of the right eye increased to 8/10, and SRF disappeared.

Ocular tuberculosis should be considered in the differential diagnosis of bilateral retinal vasculitis associated with choroiditis in Iran. PCR of vitreous sample could confirm the diagnosis. Intravitreal injection of triamcinolone and bevacizumab is a treatment option for inflammatory CNV secondary to ocular TB.