Subretinal Hemorrhage Complicating Retinal Angiomatous Proliferation in Tubercular Retinal Vasculitis

ABSTRACT

Purpose

To report a patient with submacular hemorrhage due to retinal angiomatous proliferation (RAP) in tubercular retinal vasculitis (TRV).

Methods

Case report

Results

We report a 33-year-old Asian Indian patient of TRV presenting with capillary non-perfusion areas, submacular hemorrhage and venous loops. The patient presented with sudden onset decrease in vision in the right eye. Multimodal imaging revealed presence of retinal vascular anastomosis and stage 2 RAP. Systemic examination was within normal limits. Laboratory evaluation revealed positive Mantoux and interferon gamma release assay. He underwent right eye intravitreal injection of recombinant tissue plasminogen activator (12.5µg/0.1ml) with 100% sulphur hexafluoride (SF6) tamponade. The patient had successful displacement of the submacular hemorrhage with some improvement in visual acuity.

Conclusion

This case highlights that rare vascular alterations such as RAP can develop in subjects with ocular tuberculosis.

KEYWORDS:

• Ocular tuberculosis
• optical coherence tomography
• retinal angiomatous proliferation
• venous loops
• subretinal hemorrhage

Acknowledgments

We would like to acknowledge the efforts of Mr. Arun Kapil, Mr. Sushil Bhatt, and Mr. Nitin Gautam who helped in the acquisition of images in our case.

Declaration of interest

The authors have no financial disclosure/proprietary interest. The authors report no conflicts of interest. The authors alone are responsible for the content and preparation of this manuscript.