Granuloma tuberculoso macular asociado a membrana neovascular tratado con terapia anti-factor de crecimiento endotelial vascular

espanolObjetivo: Proponer un nuevo tratamiento para tuberculosis oculares anadiendo terapia antifactor de crecimiento endotelial vascular (VEGF) a los tuberculostaticos sistemicos ante granulomas maculares o del nervio optico. Caso Clinico y Resultados: Mujer inmunocompetente, vacunada con Bacilo Calmette-Guerin (BCG), presento un cuadro compatible con uveitis tuberculosa: granulomas coroideos maculares y del nervio optico, y retinocoroiditis en media periferia. Fue tratada con tuberculostaticos y corticoides sistemicos con exito. Cicatrizadas las lesiones, aparecio una membrana neovascular retinocoroidea macular, que remitio con Ranibizumab intravitreo. Discusion y Conclusiones: Los pacientes no inmunodeprimidos o vacunados con BCG pueden sufrir uveitis tuberculosas. Dada la elevacion del VEGF en lesiones granulomatosas y epitelios pigmentarios de ojos infectados por Mycobacterium tuberculosis, recomendamos administrar sistematicamente anti-VEGF intravitreos, tuberculostaticos y corticoides sistemicos ante granulomas maculares o del nervio optico antes de que aparezcan membranas neovasculares, cuya incidencia se situa entre el 2 y el 3,5% EnglishObjective: To propose a new treatment for Ocular tuberculosis, adding anti-Vascular Endothelial Growth Factor (VEGF) to systemic tuberculostatics when macular or optic nerve granulomas appear. Case report and Results: Immunocompetent woman, vaccinated against tuberculosis with Calmette-Guerin Bacillus (BCG), presented a clinically compatible case with tubercular uveitis: choroidal macular and optic nerve granulomas, and medial peripheral retinochoroiditis. Thereby, it was effectively treated with tuberculostatics. Once the lesions healed , a neovascular macular retinochoroidal membrane did appear, which was successfully treated with intravitreal Ranibizumab. Discussion and Conclusions: Non-immunocompromised patients or BCG-vaccinated may suffer tubercular uveitis. Given the increase of VEGF in granulomatous lesions and pigmentary epithelium of infected eyes by Mycobacterium tuberculosis, we suggest systematically intravitreal anti-VEGF, tuberculostatics and systemic corticosteorids to treat macular or optic nerve granulomas before neovascular membranes appear, with an incidence between 2-3,5%.