Macular subretinal neovascularization in choroidal tuberculosis.

Area of Science:

• Ophthalmology
• Infectious Diseases
• Tuberculosis Research

Background:

• Tuberculosis (TB) can affect the eye, leading to choroidal tubercles and potentially serious complications.
• Miliary tuberculosis involves widespread dissemination of TB bacilli, which can manifest in the choroid.
• Ocular involvement in TB, particularly miliary choroidal tuberculosis, requires prompt diagnosis and management.

Observation:

• A 54-year-old woman presented with blurred vision and was diagnosed with miliary choroidal tuberculosis (TB) affecting both eyes.
• Fundus examination revealed 50-60 choroidal tubercles, predominantly in the posterior pole, including macular areas.
• The patient had a history of tuberculous meningitis preceding the ocular symptoms.

Findings:

• Successful resolution of choroidal tubercles and tuberculous meningitis was achieved with standard antitubercular medications.
• A unique finding was the development of macular subretinal neovascularization associated with the choroidal TB lesions, leading to disciform maculopathy.
• This case documented the highest number of choroidal tubercles reported in recent times and the first reported instance of macular subretinal neovascularization linked to choroidal TB.

Implications:

• This case highlights the potential for rare ocular complications, such as subretinal neovascularization, in patients with miliary choroidal tuberculosis.
• Early detection and comprehensive treatment of TB, including ocular manifestations, are crucial for preventing vision loss.
• Further research may explore the mechanisms underlying neovascularization in the context of choroidal tuberculosis.