Optic nerve head tubercular granuloma successfully treated with anti-VEGF intravitreal injections in addition to systemic therapy

Purpose: To describe a case of optc nerve head tubercular granuloma, unresponsive to conventonal therapy (anttubercular drugs and systemic steroids), successfully treated with ant–vascular endothelial growth factor (VEGF) intravitreal injectons in additon to systemic drugs. Methods: Case report. Results: A 44-year-old patent was referred to our clinic for progressive vision decrease in his lef eye during the preceding 4 months. A large granuloma infltratng optc nerve head was visible at funduscopic examinaton along with difuse intraocular infammaton. Workup for granulomatous uveits supported the diagnosis of presumed intraocular tuberculosis. However, the large granulomatous lesion did not show a good response to conventonal therapy for tubercular uveits (anttubercular drugs and systemic steroids). Ant-VEGF (bevacizumab) intravitreal injectons were performed as an adjunct to the ongoing therapy. Afer 2 injectons, the patent showed an almost complete regression of the lesion (demonstrated by optcal coherence tomography) and a restoraton of vision. Conclusions: Ant-VEGF intravitreal injectons should be considered in the treatment of large tubercular granulo-matous lesions in additon to conventonal systemic therapy. Optcal coherence tomography could be a suitable tool for studying and following optc nerve head granulomas.