First Author: A.Radosavljevic SERBIA
Co Author(s): D. Kovacevic Pavicevic A. Ilic D. Risimic N. Kosanovic Jakovic 0 0 0 0 0 0 0 0 0
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Multifocal choroiditis is the term used to describe numerous inflammatory lesions involving the choroid. Many vision threatening complications can occur and one of them is choroidal neovascularisation (CNV) involving the posterior pole, which is still a challenge regarding the treatment modalities and visual outcome. The purpose of this paper is to present a case of multifocal choroiditis presumably of tuberculous etiology complicated by CNV and treatment options for this disease.
Uveitis department of Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade, Serbia.
Case report of the patient treated at the Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade. Patient underwent complete ophthalmological investigation including visual acuity (VA) assessment, applanation tonometry, slit lamp and fundus examination, fluorescein angiography (FA) and optical coherence tomography (OCT). Systemic investigation included: biochemical analyses, blood count, SE rate, CRP, immunological investigation, HLA typization, serological analyses for HSV, VZV, CMV, Toxoplasma gondii, Borrelia burgdorferi, Quantiferon gold testing, Rö and CT of the thorax as well as pulmological investigation.
A 66-year-old female was examined in November 2013, due to the sudden loss of vision on the right eye. Patient had a 30-year-history of multifocal chorioretinitis of uncertain etiology, but just recently has lost the sight on the right eye. VA of the right eye (RE) was 2/60 and left (LE) 0.7. Intraocular pressure was 12 mmHg. Anterior segment had normal findings. On both eyes multifocal chorioretinal lesions were observed and on the right, intraretinal hemorrhage and edema, denoting CNV. OCT confirmed those findings. FA showed bilateral multifocal chorioretinal inactive lesions (scars) and on the right eye CNV of occult type. Out of all systemic investigations, only Quaniferon gold test had positive findings, but Roentgen scan and CT of the thorax were normal. Pulmologist was consulted and he advised only follow up, and no antituberculous treatment. Given that chorioretinitis was inactive, patient was advised only intravitreal Bevacizumab for treatment of CNV. After the patients’ consent, three doses of Bevacizumab were administered in 1-month intervals. VA of RE improved to 4/60 and LE remained 0.7 till March 2014.
Intravitreal Bevacizumab was efficacious treatment for CNV secondary to multifocal choroiditis of presumably tuberculous etiology. After the treatment, CNV regressed and visual acuity improved. The patients’ follow up is ongoing.