Clinical presentations and therapeutic effect of presumed choroidal tuberculosis

To present the clinical findings and to evaluate the therapeutic response to systemic antituberculosis (anti-TB) therapy in 18 cases of presumed choroidal TB.

Retrospective noncomparative interventional case series. Eighteen patients underwent a complete ophthalmologic examination and relevant laboratory and radiologic investigations. All patients were treated with systemic anti-TB therapy accordingly.

In 18 cases of choroidal TB, there were 8 men and 10 women ranging in age from 8 years to 52 years. Ten patients also had evidence of pulmonary TB and among of them, two patients had coexistent central nervous system TB, one patient had lymphoid TB, and one patient had abdominal TB. Those cases had varied clinical presentations including tubercle, tuberculoma, multifocal choroiditis, serpiginous like choroiditis, and/or diffuse choroiditis. Two cases (11.1%) had bilateral presentation. All patients were referred to a TB specialist to initiate a full standard course of anti-TB therapy according to the guideline of Centers for Disease Control and Prevention. Aside from one case, which worsened to panophthalmitis, the others responded to anti-TB therapy very well. None of the patients had human immunodeficiency virus and none was immunocompromised.

Choroidal TB may present as variable clinical manifestations and occasionally be misdiagnosed as intraocular tumor or metastatic tumor. In our case series, the prognosis of this disease was well by giving systemic anti-TB therapy. So all ophthalmologists especially in developing countries should have a high degree of clinical suspicion to maximally maintain visual acuity.