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J. Zhang, Y. Liu, R.A. Adelman; Antituberculosis Therapeutic Trial in Presumed Choroidal Tuberculosis . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1430.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: One third of Chinese population, over four hundred million people, have been exposed to mycobacterium tuberculosis. The purpose of this study is to assess the results of antituberculosis therapy on presumed choroidal tuberculosis. Methods: Of 16,527 fluorescein angiograms in West China Hospital from 1978 to 2002, seven cases of presumed choroidal tuberculosis were identified. Solitary or multiple choroidal nodules were the most common clinical findings. The anterior chamber was normal in all cases. Only one case had a few cells in the vitreous. Three of the seven cases had active systemic tuberculosis. All of the patients complained of blurred vision of 2 days to 3 months duration. The therapeutic trial was performed in all of the cases with streptomycin (1.0g/day, 2-4 weeks) and isoniazid (300mg/day, 1-3 months). A favorable clinical response warranted a full course of isoniazid 300mg/day for 6-18 months. Results: Of seven cases, visual acuity increased in six cases and was stable in one patient. Choroidal lesions disappeared in two cases and reduced in size with scaring in five cases. Fluorescein angiograms showed mottled fluorescence because of the pigmentary changes. No side effect of the treatment was seen. Conclusions: In a patient with solitary or multiple choroidal nodules from a country in which tuberculosis is common, the diagnosis of presumed choroidal tuberculosis should be considered. Because of the difficulty in obtaining microbiologic evidence and high rate of positive tuberculin skin test in this population, the diagnosis can be established on the basis of the ocular findings and a favorable response to a clinical trial of isoniazid and streptomycin.
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