Lee Dong Hyun, Cho Hyuna, Lee Junwon, Choi Eun Young, Lee Sung Chul, Kim Min
Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-gu, Seoul, Republic of Korea, 06273.
Department of Ophthalmology, Inha University Hospital, Inha University College of Medicine, 27, Inhangro, Jung-gu, Incheon, Republic of Korea.
Graefes Arch Clin Exp Ophthalmol. 2022 May;260(5):1641-1650. doi: 10.1007/s00417-021-05474-9. Epub 2021 Nov 4.
To investigate the clinical features and treatment outcomes of patients with choroidal tuberculoma.
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.
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. Interferon-gamma 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.
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.
探讨脉络膜结核瘤患者的临床特征及治疗效果。
在这个回顾性观察病例系列中，分析了在一所大学医院接受至少6个月随访的5例脉络膜结核瘤患者的病历。
5例患者中，1例为男性，4例为女性。总体平均年龄为38.0±9.4岁（平均随访时间：41.2±33.8个月）。3例患者进行了结核菌素皮肤试验，其中2例呈阳性。2例患者进行了干扰素-γ检测，均呈阳性。3例患者有累及肺部或其他器官的系统性结核病。5例患者接受了9.6±8.6个月的抗结核治疗。3例患者进行了全身皮质类固醇治疗，疗程为3.5±0.7个月。1例复发性血管化结核瘤患者通过单次玻璃体内注射贝伐单抗成功治疗。
脉络膜结核瘤可在无系统性结核病证据的情况下发生，且抗结核治疗后仍可复发。高度怀疑对于脉络膜结核瘤的早期检测和管理很重要。在疑似脉络膜结核瘤的病例中，即使未发现系统性结核病的放射学证据，免疫学检测呈阳性结果也足以启动抗结核治疗。抗结核治疗联合全身皮质类固醇治疗取得了良好效果。对于高度血管化的脉络膜结核瘤，可考虑玻璃体内注射抗血管内皮生长因子。
