PMC6380144_01
Color fundus photograph of the left eye. (a) At presentation, the left eye shows a subretinal mass approximately of 1.5-disc diameter in size located near superotemporal arcade with surrounding subretinal fluid extending till fovea. (b) At 2-week follow up, the choroidal tuberculoma did not show any significant change in the size. (c) At the last follow-up visit, a regressed and partially scarred tuberculoma is seen
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F1
SRF extending till fovea [Figure 1a]. SS-OCT of the left eye [Figure 2a] revealed the mass to be a lobulated, homogeneous, hyporeflective thickening of choroid with size of 1359 mum x 4047 mum, giving rise to a dome-shaped appearance of the overlying retina with subretinal moderate reflective echoes with surrounding SRF. Fundus examination of the left eye did not show any significant change in the size of choroidal tuberculoma [Figure 1b], but SS-OCT revealed a decrease in the size of tuberculoma to 1139 x 3960 mum [Figure 2b]. On examination, her BCVA was maintained to 6/5 in the left eye and fundus examination revealed a regressed and partially scarred tuberculoma in the left eye [Figure 1c].
Serial swept-source optical coherence tomography images of a case of choroidal tuberculoma of the left eye. (a) The left eye at presentation shows a lobulated, homogeneous, hyporeflective mass located in choroid with size of 1359 x 4047 mum, giving rise to a dome-shaped appearance of the overlying retina with a discrete subretinal hyperreflective lesion with surrounding subretinal fluid. (b) At 2 weeks, tuberculoma size is 1139 x 3960 mum. (c) At 10 weeks, there is slight decrease in the size of the tuberculoma (1087 x 3584 mum) with increase in surrounding subretinal fluid. Serial swept-source optical coherence tomography clearly outlines two medium reflective lesions, one located between the retinal pigment epithelium layer and Bruch's membrane and other located above the retinal pigment epithelium layer. (d) At 14 weeks, 1-month postanti-vascular endothelial growth factor injection, the tuberculoma size is 1058 x 3223 mum with partial resolution of subretinal fluid. (e) At 5-month follow-up from the day of presentation, there is complete resolution in subretinal fluid with decrease in the size of tuberculoma to 979 x 2978 mum. (f) At 7 months, tuberculoma size is 625 x 2950 mum. The overlying retinal pigment epithelium shows a discontinuity and the choroidal neovascular membrane complex is stable without any evidence of activity. (g) At 11 months, tuberculoma size is 529 x 3540 mum. The choroidal neovascular membrane complex has slightly increased in size. (h) At 12 months, tuberculoma size is 509 x 2994 microns. There is an increase in size of the choroidal neovascular membrane complex and the presence of subretinal fluid. (i) At 14 months, 2-month postanti-vascular endothelial growth factor injection, the tuberculoma size is reduced to 400 x 2391 microns with resolution of subretinal fluid and presence of scarring choroidal neovascular membrane
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F2
SRF extending till fovea [Figure 1a]. SS-OCT of the left eye [Figure 2a] revealed the mass to be a lobulated, homogeneous, hyporeflective thickening of choroid with size of 1359 mum x 4047 mum, giving rise to a dome-shaped appearance of the overlying retina with subretinal moderate reflective echoes with surrounding SRF. Fundus examination of the left eye did not show any significant change in the size of choroidal tuberculoma [Figure 1b], but SS-OCT revealed a decrease in the size of tuberculoma to 1139 x 3960 mum [Figure 2b]. SRF in SS-OCT of the left eye. SS-OCT clearly outlined two medium reflective lesions, one located between the RPE layer and Bruch's membrane and other located above the RPE layer [Figure 2c]. SS-OCT was approximately 1058 x 3223 mum [Figure 2d]. She was advised to continue ATT and maintenance dose of oral prednisolone of 10 mg/day. At 5-month follow-up from the day of presentation, her BCVA improved to 6/6 and SS-OCT showed complete resolution in SRF with decrease in the size of the tuberculoma to 979 x 2978 mum [Figure 2e]. SS-OCT demonstrated a further decrease in size of the tuberculoma to 625 x 2950 mum [Figure 2f]. SS-OCT revealed a progressive decrease in size of the choroidal tuberculoma to 529 mum x 3540 mum [Figure 2g] and 509 mum x 2994 mum [Figure 2h], respectively. Size of the choroidal tuberculoma had regressed to 400 x 2391 microns in SS-OCT [Figure 2i] with scarring of CNVM.
Fundus fluorescein angiography of the left eye at 10 weeks of presentation. (a) A small area of hypofluorescence overlying the lesion surrounded by hyperfluorescence in the early phase. (b and c) There is progressive staining of lesion in the late phase
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F3
Fundus fluorescein angiography (FFA) of the left eye showed a small area of hypofluorescence overlying the lesion surrounded by hyperfluorescence in the early phase with progressive staining of lesion in late phase [Figure 3].