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Photo Essay |

Treatment of Large Macular Choroidal Tubercle Improves Vision

John O. Mason, MD
Arch Ophthalmol. 2000;118(8):1136. doi:10.1001/archopht.118.8.1136.
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A 45-YEAR-OLD black woman with human immunodeficiency virus was evaluated for slowly decreasing vision in her left eye for 2 months. Findings from systemic review included a persistent cough and night sweats for 3 months. At initial examination, she had a visual acuity of 20/20 OD and counting fingers OS. Findings from the anterior segment and vitreous examination were normal in both eyes. Results of a posterior segment examination of the left eye revealed a 5 × 5-mm white choroidal lesion that was 3.5-mm thick by B-scan ultrasonography (acoustically dense, high internal reflectivity, and no choroidal excavation) (Figure 1). Fluorescein angiography demonstrated early blockage and late staining of the lesion (Figure 2 and Figure 3).

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Figure 1.

B-scan ultrasonogram of the left eye showing an acoustically dense choroidal lesion with no choroidal excavation.

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Figure 2.

Fluorescein angiogram in the early venous phase showing early blockage at the edges of the lesion and early hyperfluorescence within the central aspect of the choroidal lesion; the overlying retinal vessels are normal and in focus. The other retinal vessels are not in focus secondary to the thickness of the lesion.

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Figure 3.

Fluorescein angiogram in the late phase revealing late staining of the choroidal lesion.

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Figure 4.

Fundus photograph showing a white choroidal lesion causing the fovea to be ectopic.

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Figure 5.

Fundus photograph of the left eye showing resolution of the choroidal tubercle with retinal pigment epithelium stippling within the resolving choroidal tubercle.

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Figure 6.

B-scan ultrasonogram showing an acoustically dense choroidal lesion that is much smaller than prior to treatment and is approximately 1½ mm in thickness; the crosses show the anterior and posterior extent of the lesion.

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