Clinical features and long-term treatment outcomes in choroidal tuberculoma

Purpose To investigate the clinical features and treatment outcomes of patients with choroidal tuberculoma. Methods In this retrospective, observational case series, the medical records of five patients with choroidal tuberculoma who were followed up at a university hospital for at least 6 months were analyzed. Results Of five patients, one was male and four were female. The overall mean age was 38.0 +/- 9.4 years (mean follow-up: 41.2 +/- 33.8 months). Tuberculin skin test was performed in three patients, and it was positive in two of them. Interferongamma assay was performed in two patients and was positive in all two. Three patients had systemic tuberculosis involving the lung or other organs. Five patients were treated with antitubercular therapy for a period of 9.6 +/- 8.6 months. Systemic corticosteroid treatment was performed in 3 patients, with a period of 3.5 +/- 0.7 months. One patient with a recurrent vascularized tuberculoma was successfully treated with single intravitreal bevacizumab injection. Conclusion Choroidal tuberculoma can develop without evidence of systemic tuberculosis and can recur despite antitubercular treatment. High index of suspicion is important in early detection, and management of choroidal tuberculoma. In cases of suspected choroidal tuberculoma, positive results on immunological tests would be sufficient to initiate antitubercular therapy even if radiological evidence of systemic tuberculosis is not found. Antitubercular therapy combined with systemic corticosteroids provided favorable results. Intravitreal injection of anti-vascular endothelial growth factor may be considered for highly vascularized choroidal tuberculoma.