Ocular Tuberculosis in Advanced Proliferative Diabetic Retinopathy: A Diagnostic and Therapeutic Dilemma in A Vitrectomized Eye
DOI:
https://doi.org/10.37275/bsm.v10i11.1675Keywords:
Cystoid macular edema, Intraocular inflammation, Ocular tuberculosis, Proliferative diabetic retinopathy, Sub-Tenon triamcinolone acetonide, Vitrectomized eye, Vitreous polymerase chain reactionAbstract
Background: Ocular tuberculosis (OTB) is a paucibacillary extrapulmonary infection, hard to recognize in an eye compromised by proliferative diabetic retinopathy (PDR) and vitreoretinal surgery, where postoperative inflammation, tamponade artifacts, hemorrhage and diabetic microangiopathy mimic infectious uveitis.
Objective: To characterize the diagnosis, molecular confirmation, and longitudinal outcomes of occult ocular tuberculosis in a vitrectomized eye with end-stage proliferative diabetic retinopathy.
Methods: A 50-year-old man with type 2 diabetes and pulmonary tuberculosis presented with acute inflammation (OD) 5 days after pars plana vitrectomy. He was followed over six milestones (T0–T5, 16 weeks) with SD-OCT and vitreous nested RT-PCR (IS6110/MPB64); outcomes were best-corrected acuity (LogMAR), intraocular pressure and central macular thickness (CMT).
Results: At T0 (OD 1/300, LogMAR 2.48) with ciliary flush and gas endotamponade, vitreous RT-PCR was positive for M. tuberculosis DNA (IS6110/MPB64), establishing intraocular tuberculosis masked by surgical inflammation. Quadruple antituberculous therapy (RHZE) with corticosteroids improved vision to 6/30 (LogMAR 0.70) by week 3 and 6/21 (LogMAR 0.54) by week 6. At week 7, SD-OCT unmasked diabetic cystoid macular edema (CMT 365 µm) that responded to sub-Tenon triamcinolone (CMT 340 µm), with final acuity 6/9.5 corrected (LogMAR 0.20) at week 16. The contralateral eye (OS) developed neovascular glaucoma (IOP 51.0–63.0 mmHg) and no light perception, requiring silicone oil evacuation.
Conclusion: Ocular tuberculosis must be suspected in atypical intraocular inflammation in vitrectomized eyes, especially with tuberculosis or diabetes. Vitreous PCR is decisive when signs overlap with surgical trauma and diabetic microangiopathy, and prompt antituberculous plus corticosteroid therapy can achieve visual salvage.
Authors
- Pritha Amelia Nuraini Pattisahusiwa1*
- I Gusti Ayu Made Juliari1
- Ari Andayani1
- 1Department of Ophthalmology, Prof. Dr. I.G.N.G. Ngoerah Hospital, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
Corresponding author Pritha Amelia Nuraini Pattisahusiwa — prithamelia@gmail.com
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Copyright (c) 2026 Pritha Amelia Nuraini Pattisahusiwa, I Gusti Ayu Made Juliari, Ari Andayani
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