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This 70YO female with a history of Type 2 diabetes presented with 2 weeks of vision loss in her right eye. Vision was counting fingers OS and 20/30 OS.
Optos color RGB imaging of her right eye shows a whitish placoid subretinal macular and peripapillary lesion with nerve swelling and peripapillary hemorrhages. Multifocal macular and peripapillary scars are present OS, with overlying orange pigment and radiating nasal macular lipid. Fundus autofluorescence (FAF) shows hyper-FAF of the placoid lesion OD and variable hyper- and hypo-FAF from the multifocal lesions OS.
Triton swept-source OCT OD shows areas of hyperreflective subretinal vs outer retinal hyperreflective material more superiorly and a large bacillary layer detachment more inferiorly. OCT scanning OS shows variable ellipsoid zone disruption with hyperreflective nasal lipid flecks in the outer plexiform and inner and outer nuclear layers.
QuantiFERON-TB testing was positive, and chest X-ray revealed a mass-like opacity in the posterior right upper lobe. She was referred to infectious disease and started on anti-tuberculosis treatment (ATT).
The funduscopic, FAF, and OCT findings dramatically improved after 4 weeks of ATT. Vision improved to 20/25 OU. We continue to follow her closely.
Learning Points:
Although tuberculosis (TB) most commonly presents with pulmonary involvement, extrapulmonary sites can include the gastrointestinal, skin, cardiovascular, genitourinary, and central nervous systems, including the eyes. Ocular involvement, like syphilis, can mimic virtually any type of uveitis, including anterior, intermediate, posterior, and panuveitis, retinitis and retinal vasculitis, neuroretinitis, optic neuropathy, choroidal granuloma (our patient), choroiditis, and scleritis. For an excellent review of intraocular tuberculosis, see Bupta et al, Survey Ophthalmology 2007;52:561-587.
Retina. 2026 Sep 1;46(9):1520-1531. doi: 10.1097/IAE.0000000000004858.
DME Eylea+Ozurdex vs Eylea monotherapy: Combined Rx similar VA and anatomic outcomes with quicker DME resolution, BUT higher risk for cataract and increased IOP (COED Trial) — Prospective, RCT, 50 patients
Purpose: To compare combined dexamethasone implant and intravitreal aflibercept (AFB) to AFB monotherapy treatment in diabetic macular edema (DME).
Methods: This open-label randomized clinical trial involved randomization of patients with DME (n = 50) to pro re nata treatment with combined dexamethasone and AFB or AFB alone according to prespecified retreatment criteria. Best-corrected visual acuity, central subfield retinal thickness (CST), and adverse events were monitored monthly for 48 weeks.
Results: The combined treatment and the AFB monotherapy group demonstrated CST reductions at each visit. The difference (95% confidence intervals [CI]) in the change from baseline in CST between the groups was -32.9 (-81.5 to 15.6) µ m at week 48, favoring the combination therapy group without significance ( P = 0.183). The difference in the change from baseline in best-corrected visual acuity was -3.3 (-9.2 to 2.5) letters read at week 48 ( P = 0.266). Injection number was numerically higher in the aflibercept monotherapy group (mean ± SD, 5.9 ± 1.8) than in the combination group (4.9 ± 1.5). The AFB monotherapy group had a 90% higher injection rate over the study period (incidence rate ratio [95% CI] = 1.9 [0.9-4.0]) without statistical significance ( P = 0.081). The combined treatment group achieved quicker time to resolution of DME (log-rank P -value = 0.013) by a median difference (95% CI) of 12 (0-24) weeks. Three eyes and two eyes in the combined therapy group developed worsening cataracts and intraocular pressure elevation requiring medical management, respectively.
Conclusion: Combined treatment achieved similar anatomic and visual outcomes compared with AFB monotherapy, with quicker DME resolution but higher cataract and intraocular pressure risks.
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