Pars Plana Vitrectomy in Tuberculous Endophthalmitis: A Case Report

Abstract

Introduction: Ocular tuberculosis (TB) is an extrapulmonary mycobacterial disease with varied manifestations. Endophthalmitis is a severe manifestation with a rapid progression that may lead to intraocular tissue destruction and panophthalmitis. This study aimed to report a case of tuberculous endophthalmitis treated with pars plana vitrectomy (PPV).

Case presentation: A 57-year-old male patient with TB endophthalmitis. The follow-up period was 6 months. The diagnosis was made on a clinical basis, and the specific etiology was confirmed by TST and IGRA tests. The diagnosis of ocular TB was delayed by one year. He had bilateral endophthalmitis with severe inflammation. The right eye (OD) was blind, and the left (OS) had best-corrected visual acuity (BCVA) of hand motion. Intraocular pressure (IOP) was elevated in both eyes. B-scan disclosed hyperreflective exudate, filling 1/3 of the vitreous cavity in OD, and vitritis and intravitreal hemorrhage in OS. We commenced triple antitubercular therapy. 23G PPV with silicone oil and phacoemulsification with IOL implantation were done. The intraocular inflammation in OS decreased postsurgically, and in one month, BCVA was 20/200 and IOP was within normal limits.

Conclusion: Eendophthalmitis is an indication for therapeutic vitrectomy. The risks of surgery seem to be lower than the benefits, including a decent chance for visual improvement and avoidance of enucleation. In our case, 23G PPV with phacoemulsification seemed to be beneficial in decreasing the level of inflammation, improvement of visual acuity, reduction of IOP, and preservation of the eye.