Sembiring Sindy B, Silitonga Andrea R, Nora Rina La D
Vitreoretina, SMEC (Sabang Merauke Eye Center) Eye Hospital, Medan, IDN.
Ophthalmology and Visual Sciences, Universitas Prima Indonesia, Medan, IDN.
Cureus. 2025 Aug 20;17(8):e90615. doi: 10.7759/cureus.90615. eCollection 2025 Aug.
Tubercular retinal vasculitis (TRV) is an ocular manifestation of that can lead to vision-threatening complications such as recurrent vitreous hemorrhage and cystoid macular edema (CME). Even after completing a full course of anti-tubercular therapy (ATT), persistent intraocular inflammation may drive delayed recurrences of CME, highlighting the need for vigilant, escalation-based management. We report a case of a 31-year-old Indonesian woman who presented with sudden-onset hand motion vision in her left eye. Fundus examination was obscured by dense vitreous hemorrhage, and B-scan ultrasonography confirmed an attached retina. Diagnostic workup revealed a positive interferon-γ release assay and apical infiltrates on chest radiography, with no alternative etiology, supporting a diagnosis of presumed TRV. The patient was treated with a standard nine-month course of ATT and tapering oral corticosteroids. Due to progressive retinal ischemia, pan-retinal photocoagulation was performed. Recurrent vitreous hemorrhages and persistent CME necessitated a posterior sub-Tenon triamcinolone injection and 23-gauge pars plana vitrectomy with endolaser at month 9. Fifteen months postoperatively, best-corrected visual acuity had improved to 20/20, with complete CME resolution. The purpose of this case report is to describe the management of TRV through a progressive escalation of therapy and to outline practical treatment considerations for clinicians working in tuberculosis (TB)-endemic regions. This case also illustrates that early ATT alone may be insufficient to prevent structural complications in TRV. A stepwise, multimodal approach combining systemic therapy, laser photocoagulation, periocular corticosteroids, and timely vitrectomy can restore excellent vision and reduce the risk of recurrent CME. Clinicians managing patients in TB-endemic areas should maintain close optical coherence tomography (OCT)-guided monitoring of CME and be prepared to escalate treatment promptly to prevent irreversible visual loss.
结核性视网膜血管炎（TRV）是一种疾病的眼部表现，可导致威胁视力的并发症，如反复性玻璃体积血和黄斑囊样水肿（CME）。即使完成了全程抗结核治疗（ATT），持续性眼内炎症仍可能导致CME延迟复发，这凸显了基于逐步升级的警惕性管理的必要性。我们报告一例31岁印度尼西亚女性病例，其左眼突然出现仅能感知手动的视力。眼底检查因浓密的玻璃体积血而无法看清，B超检查证实视网膜附着。诊断性检查显示干扰素-γ释放试验阳性，胸部X线片显示肺尖浸润，且无其他病因，支持推定的TRV诊断。该患者接受了为期9个月的标准ATT疗程以及逐渐减量的口服糖皮质激素治疗。由于视网膜进行性缺血，遂行全视网膜光凝术。反复性玻璃体积血和持续性CME需要在第9个月时进行后Tenon囊下曲安奈德注射以及23G经平坦部玻璃体切除术联合眼内激光治疗。术后15个月，最佳矫正视力提高到20/20，CME完全消退。本病例报告的目的是描述通过逐步升级治疗来管理TRV的方法，并概述为在结核病（TB）流行地区工作的临床医生提供切实可行的治疗考虑因素。该病例还表明，仅早期进行ATT可能不足以预防TRV中的结构性并发症。结合全身治疗、激光光凝、眼周糖皮质激素和及时的玻璃体切除术的逐步多模式方法可以恢复良好视力并降低CME复发风险。在TB流行地区管理患者的临床医生应通过光学相干断层扫描（OCT）密切监测CME，并准备好迅速升级治疗以防止不可逆转的视力丧失。
