Adjunctive intravitreal anti-vascular endothelial growth factor and moxifloxacin for treating a large choroidal tuberculoma

This case report describes a 59-year-old male presented with choroidal tuberculoma, macular exudation, and orbital cellulitis. Initial treatment with oral steroids and antituberculosis therapy (ATT) resulted in partial symptom improvement but worsened vision. Upon referral, examination revealed increased macular exudation and active orbital cellulitis. The patient was then treated with intravitreal ranibizumab and moxifloxacin, and ATT was continued. After three months, the combination therapy led to dramatic improvements, with complete regression of the granuloma, resolution of macular exudation, and likely resolution of orbital cellulitis, possibly due to reduced vascular permeability. The best-corrected visual acuity significantly improved. This case highlights the potential efficacy of combining intravitreal anti-VEGF therapy and moxifloxacin with ATT in managing refractory intraocular tuberculosis, especially when conventional treatments fail. Although further research is needed, this approach may be considered in the treatment of complex intraocular tuberculosis cases.