Patricio Maria Sara, Portelinha Joana, Passarinho Maria Picoto, Guedes Marta Esteves
Department of Ophthalmology, Hospital de Egas Moniz, Lisbon, Portugal.
BMJ Case Rep. 2013 Jun 3;2013:bcr2013008924. doi: 10.1136/bcr-2013-008924.
Intraocular tuberculosis (TB) infection can have different clinical manifestations including retinal vasculitis. It more frequently involves the veins and is associated with retina haemorrhages and neovascularisation. The diagnosis may be difficult and presumptive being based on clinical findings and evidence of systemic TB infection. The authors present a case of a 61-year-old woman with blurred vision and floaters in her left eye for 6 years, associated with recurrent vitreous haemorrahages. A temporal branch retinal vein occlusion was presumed. Four years later her right eye was also involved. Her best-corrected visual acuity (BCVA) was 20/50 in both eyes. Fundoscopic examination showed bilateral venous occlusion with vascular staining on fluorescein angiography suggestive of vasculitis secondary to Eales Disease (ED). The interferon gamma release assay (IGRA-QuantiFERON-TB Gold) was positive and antituberculosis treatment (ATT) was started. Her final BCVA was 20/20 bilaterally, without recurrences over a follow-up of 15 months. The use of ATT is likely to reduce recurrent vitreous haemorrhages and eliminate future recurrences.
眼内结核感染可有不同的临床表现,包括视网膜血管炎。它更常累及静脉,并伴有视网膜出血和新生血管形成。诊断可能困难,基于临床发现和全身结核感染证据进行推测性诊断。作者报告了一例61岁女性,左眼视物模糊和有飞蚊症6年,伴有反复玻璃体出血。推测为颞支视网膜静脉阻塞。4年后,她的右眼也受累。她双眼的最佳矫正视力(BCVA)均为20/50。眼底检查显示双侧静脉阻塞,荧光素血管造影有血管染色,提示伊尔斯病(ED)继发的血管炎。干扰素γ释放试验(IGRA-结核感染T细胞检测)呈阳性,开始抗结核治疗(ATT)。她最后的BCVA双眼均为20/20,在15个月的随访中无复发。使用ATT可能会减少反复玻璃体出血并消除未来的复发。