title: Optic nerve head tubercular granuloma successfully treated with anti-VEGF intravitreal injections in addition to systemic therapy.
abstract: OBJECTIVE
  To describe a case of optic nerve head tubercular granuloma, unresponsive to conventional therapy (antitubercular drugs and systemic steroids), successfully treated with anti-vascular endothelial growth factor (VEGF) intravitreal injections in addition to systemic drugs.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 44-year-old patient was referred to our clinic for progressive vision decrease in his left eye during the preceding 4 months. A large granuloma infiltrating optic nerve head was visible at funduscopic examination along with diffuse intraocular inflammation. Workup for granulomatous uveitis supported the diagnosis of presumed intraocular tuberculosis. However, the large granulomatous lesion did not show a good response to conventional therapy for tubercular uveitis (antitubercular drugs and systemic steroids). Anti-VEGF (bevacizumab) intravitreal injections were performed as an adjunct to the ongoing therapy. After 2 injections, the patient showed an almost complete regression of the lesion (demonstrated by optical coherence tomography) and a restoration of vision.
  
  
  CONCLUSIONS
  Anti-VEGF intravitreal injections should be considered in the treatment of large tubercular granulomatous lesions in addition to conventional systemic therapy. Optical coherence tomography could be a suitable tool for studying and following optic nerve head granulomas.
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Invernizzi
authors.forename: Fabio
authors.initials: F
authors.lastname: Franzetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Viola
authors.forename: Luca
authors.initials: L
authors.lastname: Meroni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Staurenghi
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use*; D000068258:Bevacizumab; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000187:drug effects* / Q000473:pathology; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000188:drug therapy*; D041623:Tomography, Optical Coherence; D014375:Tuberculoma / Q000175:diagnosis / Q000188:drug therapy*; D014392:Tuberculosis, Ocular / Q000175:diagnosis / Q000188:drug therapy*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D005938:Glucocorticoids; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab