Adjunctive Intravitreal moxifloxacin and ranibizumab in the Management of Intraocular Tuberculoma.

PURPOSE To evaluate the role of adjunctive intravitreal moxifloxacin and ranibizumab in the management of recalcitrant and treatment-naïve cases of intraocular tuberculoma.

METHODS The study included 10 eyes of 9 patients diagnosed with intraocular tuberculoma between June 2022 and March 2025 at a tertiary eye care centre in India. .All patients received systemic therapy and biweekly intravitreal injections of moxifloxacin (500 µg/0.1 mL) and ranibizumab (0.5 mg/0.05 mL) until clinical and anatomical regression of the tuberculoma. Patients were stratified into two groups: Group A (recalcitrant cases) and Group B (treatment-naïve cases).Data on imaging features, number of injections, and visual acuity outcomes were analysed.

RESULTS Group A cases (n=3) had peripheral or ciliary body granulomas and received a 9-month ethambutol-sparing anti-tubercular treatment (ATT) regimen along with local therapy. Two eyes achieved a final visual acuity of 6/6, while one developed cataract with secondary angle closure glaucoma. Group B(n=7) included 4 macular granulomas and 3 cases with panuveitis and peripheral lesions. The three macular cases required fewer than three injections, achieving 6/6 visual outcomes. Two cases experienced reactivation and responded well to repeat local and systemic therapy.

CONCLUSION Adjunctive intravitreal moxifloxacin and ranibizumab, when combined with systemic ATT and corticosteroids, appears to be a valuable therapeutic option in the management of intraocular tuberculoma, especially in cases with macular involvement. Tailored local therapy based on clinical phenotype may enhance lesion control and reduce systemic treatment duration.