Stromal Keratitis: An Ocular Presentation Of Tuberculosis

To present a case of tuberculosis keratitis and clinical features of the disease and the role of AS-
OCT in diagnosis.

 University clinic Bogomolets National Medical University

Case report. A 50-year-old patient presented to the ophthalmology clinic with complaints of persistent ocular redness, a foreign body sensation in the right eye lasting over one month, and progressive visual deterioration over the past five months. Upon examination, uncorrected visual acuity in the right eye was measured at 0.08, with preserved light perception. The patient had a confirmed diagnosis of tuberculosis, complicated by secondary ocular hematogenous involvement, which was considered in the differential assessment and interpretation of ocular findings.

Slit-lamp examination showed significant conjunctival congestion, deep corneal neovascularization, and confluent disc-shaped stromal infiltrates. The intraocular pressure in the right eye was measured at 15 mm Hg, and fundus examination revealed no abnormalities within the visible area. Corneal sensation was intact bilaterally. Optical coherence tomography of the anterior segment (AS-OCT) revealed stromal thinning, leading to reduced overall corneal thickness while preserving epithelial thickness. Hyporeflective areas were observed amidst general hyperreflectivity of the corneal tissue, consistent with neovascularization. This pattern, commonly referred to in the literature as a “barcode” appearance, is indicative of neovascularization

Based on the preliminary examination, oral antituberculosis treatment with isoniazid, rifampicin, pyrazinamide and
ethambutol was started.The patient used topical corticosteroid eye drops for 6 times a day, moxifloxacin
for 4 times a day and cyclopentalate 1 time a day. Additionally, moisturizing drops based on hyaluronic
acid and vitamin B12 were used. After the prescribed therapy, the patients best corrected visual acuity
was 0.4, conjunctival congestive injection disappeared, and corneal stromal infiltration decreased while
corneal neovascularization remained.