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JAMA Ophthalmology Clinical Challenge |

Management of Choroidal Granulomas Involving the Macula in Corticosteroid-Intolerant Patients QUIZ

Eric K. Chin, MD1; David R. P. Almeida, MD, MBA, PhD1; Vinit B. Mahajan, MD, PhD1
[+] Author Affiliations
1Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City
JAMA Ophthalmol. 2015;133(11):1351-1352. doi:10.1001/jamaophthalmol.2015.1951.
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A man in his 40s with a history of chronic blurry vision in both eyes had latent extrapulmonary tuberculosis that had been treated with antitubercular therapy 1 year earlier. Oral prednisone provided visual improvement, but the therapy was complicated by avascular hip necrosis. What would you do next?

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Figure 1.

Large choroidal tuberculoma at presentation. In a fundus view of the right eye, a moderate amount of subretinal fluid is seen adjacent to the lesion, involving the fovea center. B-scan (not shown) measured an apical height of 3.4 mm.

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Figure 2.

Choroidal tuberculoma at follow-up. A, One week after vitrectomy at the time of dexamethasone intravitreous implant placement. B-scan (not shown) measured an apical height of 3.1 mm. B, One month after surgery there was complete resolution of subretinal fluid, and B-scan measured an apical height of 1.6 mm.

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