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Mohit Dogra, Ramandeep Singh; Role of Intravitreal Anti VEGF agents in the management of Tubercular choroidal and optic disc granulomas. Invest. Ophthalmol. Vis. Sci. 2018;59(9):214.
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© ARVO (1962-2015); The Authors (2016-present)
Tubercular (TB) granulomas are conventionally managed with oral steroids and 4 drug Anti-tubercular therapy (ATT). Oral steroids are required for 3-4 months and ATT is given for 9-12 months. Recurrences are commonly seen in these patients once steroids are tapered. Long duration of treatment along with high rates of recurrence of these granulomas are major management challenges. Robust evidence to support the use of intravitreal therapy for TB granulomas is lacking. Experimental studies have show the "VEGF dependancy" of TB granulomas. Hence, it seemed prudent to utilise intravitreal Anti VEGF agents against TB granulomas and avoid prolonged treatment with oral steroids/ATT
Retrospective, observational case series of patients with tubercular choroidal and optic disc granulomas, who received intravitreal Anti VEGF agents. We included patients who received these agents as adjuncts to oral steroids as well as those who were exclusively managed with these agents (without oral steroids/ATT)
12 eyes of 12 patients were included-11 had choroidal and 1 had optic disc granuloma. Mean follow up was 12.6 months(range 4-48 months). All patients showed complete resolution of granuloma and surrounding subretinal fluid. Mean number of intravitreal Anti VEGF injections received were 1.67(range 1-3). Recurrence was seen in 2 patients (16.67%), at 17 months and 24 months, respectively. Both recurrences were successfully managed with 1 intravitreal Anti VEGF injection, without the need for oral steroids. 2 patients (16.67%) were treated exclusively with these agents and showed resolution of their granulomas, without any recurrence
Intravitreal Anti VEGF agents lead to reduction in size, resolution of subretinal fluid and normalization of choroidal thickness in patients of tubercular granulomas. These agents cause granuloma resolution when used as adjuncts to oral steroids and ATT and also when used as monotherapy for treating TB granulomas.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Left eye of a patient with a vascularized TB optic disc granuloma with peripapillary haemorrhages treated with intravitreal bevacizumab. Over 6 months follow up, complete resolution of the optic disc granuloma is seen
Left eye of a patient with a macular TB choroidal granuloma with subretinal fluid, showing complete resoution of the granuloma with normalization of choroidal architecture, after a single intravitreal ranibizumab injection
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