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Delayed suprachoroidal haemorrhage following trabeculectomy bleb needling

1999; BMJ; Volume: 83; Issue: 6 Linguagem: Inglês

10.1136/bjo.83.6.753f

1468-2079

Lucy Howe, Phillip Bloom,

Intraocular Surgery and Lenses

Indocyanine green angiography in choroidal tuberculomasEDITOR,-An 85 year old white woman presented with progressive asthenia, fever, coughing, and dyspnoea.Chest roentgenogram showed interstitial pulmonary infiltrates and right pleural eVusion.Cultures of the bronchoalveolar lavage fluid subsequently confirmed the presence of Mycobacterium tuberculosis.On admission, best corrected visual acuity was 20/400 in a right amblyopic eye and 20/50 in the left eye.Biomicroscopic examination revealed no sign of anterior or posterior inflammation.Multiple choroidal lesions (Fig 1) were present in both eyes.The choroidal lesions were deep, white-yellowish, with indistinct borders.Fluorescence angiography (FA) revealed early nodular hypofluorescence, and late moderate hyperfluorescence (Fig 2).Indocyanine green (ICG) angiography revealed prolonged hypofluorescence and in the late stage images, moderate delineation of the lesions by a peripheral hyperfluorescent ring (Fig 3).COMMENT Ocular tuberculosis may occur by haematogenic spread from a pulmonary focus.Choroidal tuberculomas are rare ophthalmic findings even in miliary tuberculosis. 1Previous reports indicate that these lesions have prolonged hypofluorescence in FA, and late mild hyperfluorescence. 2 3Only one description of ICG angiography in a case with presumed ocular tuberculosis has been reported previously in the literature. 4 We found similar angiographic characteristics in our case, which represents, to our knowledge, the first ICG angiography description of multiple choroidal tuberculomas in microbiologically confirmed miliary tuberculosis.Hypofluorescence in ICG images may be due to a masking eVect of the choroidal vessels by the overlying granulomas.Ophthalmic examination may be contributive when disseminated tuberculosis is suspected.In this case ICG angiography, which was performed to assess the choroidal involvement, showed prolonged hypofluorescence.