Vision restored: A network of vessels receding in a healthy eye after tubercular granuloma treatment.

Vision Restored: How Anti-VEGF Injections Offer New Hope for Tubercular Eye Granulomas

Lena Voss in Health & Wellness December 2025 • 4 min read.

"A groundbreaking case study reveals the potential of anti-VEGF therapy in treating a rare and sight-threatening complication of ocular tuberculosis, offering a beacon of hope for patients unresponsive to traditional treatments."

Ocular tuberculosis (TB) can manifest in various ways, one of the most concerning being the development of optic nerve head (ONH) granulomas. These granulomas are rare but pose a significant threat to vision. They are essentially inflammatory masses that form on the optic nerve, disrupting its function and potentially leading to severe vision loss.

Traditionally, ocular TB, including granulomas, has been treated with a combination of systemic steroids to control inflammation and anti-tubercular therapy (ATT) to eradicate the underlying infection. While this approach is often effective, some granulomas, particularly larger ones, can prove resistant to conventional treatment. This resistance is thought to be due to the development of internal neovascularization, where new blood vessels form within the granuloma, sustaining its growth and inflammatory activity.

A recent case study offers a promising alternative approach for these resistant cases. The study, published in the European Journal of Ophthalmology, details the successful treatment of a patient with a large ONH tubercular granuloma that did not respond to traditional therapies. The innovative approach involved the use of anti-VEGF (vascular endothelial growth factor) intravitreal injections in conjunction with systemic medications. This combined strategy led to a significant reduction in the granuloma and a remarkable restoration of the patient's vision.

Anti-VEGF to the Rescue: A Novel Approach to Treating Resistant Granulomas

Vision restored: A network of vessels receding in a healthy eye after tubercular granuloma treatment.

The case study involved a 44-year-old man who experienced progressive vision loss in his left eye over four months. Upon examination, doctors discovered a large granuloma infiltrating his optic nerve head, accompanied by widespread intraocular inflammation. Standard tests pointed to a presumed diagnosis of intraocular tuberculosis.

Despite undergoing conventional treatment with systemic steroids and anti-tubercular drugs, the granuloma showed minimal improvement. This prompted the medical team to try a different tactic: anti-VEGF intravitreal injections. These injections contain medications that block vascular endothelial growth factor (VEGF), a protein that stimulates blood vessel growth. By inhibiting VEGF, the injections aim to reduce neovascularization within the granuloma, cutting off its blood supply and promoting its regression.

The Procedure: The patient received intravitreal injections of bevacizumab, a commonly used anti-VEGF drug.
The Results: After just two injections, the patient experienced a dramatic improvement. Optical coherence tomography (OCT), a sophisticated imaging technique, confirmed the near-complete regression of the granuloma.
Vision Restoration: More importantly, the patient's vision was significantly restored.
Follow-Up: Systemic steroids were gradually tapered, while anti-tubercular therapy was continued for the recommended six months.

This case highlights the potential of anti-VEGF injections as an adjunctive therapy for large tubercular granulomas that are unresponsive to conventional treatment. By targeting the neovascularization within the granuloma, these injections can effectively reduce its size and improve visual outcomes.

Looking Ahead: The Future of Granuloma Treatment

The successful outcome of this case suggests that anti-VEGF intravitreal injections should be considered as a valuable tool in the management of large tubercular granulomas, particularly when conventional therapies fail. Optical coherence tomography (OCT) also proved to be a useful tool for monitoring the regression of the granuloma and assessing the response to treatment. Further research is needed to confirm these findings and to explore the optimal use of anti-VEGF therapy in ocular tuberculosis. However, this case offers a promising glimpse into the future of granuloma treatment, providing hope for patients facing this challenging condition.

About this Article -

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This article is based on research published under:

DOI-LINK: 10.5301/ejo.5000528, Alternate LINK

Title: Optic Nerve Head Tubercular Granuloma Successfully Treated With Anti-Vegf Intravitreal Injections In Addition To Systemic Therapy

Subject: Ophthalmology

Journal: European Journal of Ophthalmology

Publisher: SAGE Publications

Authors: Alessandro Invernizzi, Fabio Franzetti, Francesco Viola, Luca Meroni, Giovanni Staurenghi

Published: 2014-10-31

Everything You Need To Know

What are tubercular eye granulomas and how are they traditionally treated?

Ocular tuberculosis can lead to the formation of optic nerve head granulomas, which are inflammatory masses on the optic nerve. These granulomas can severely impair vision. The standard treatment involves systemic steroids to manage inflammation and anti-tubercular therapy to eliminate the underlying infection. However, larger granulomas sometimes resist this conventional treatment due to internal neovascularization, where new blood vessels develop within the granuloma, fueling its growth.

How do anti-VEGF intravitreal injections help in treating tubercular granulomas?

Anti-VEGF intravitreal injections are used to treat tubercular granulomas by targeting vascular endothelial growth factor (VEGF). VEGF is a protein that promotes blood vessel growth. By blocking VEGF, these injections aim to reduce the neovascularization within the granuloma, effectively cutting off its blood supply. This can lead to a reduction in the size of the granuloma and improvement in vision. Bevacizumab is a commonly used anti-VEGF drug.

What were the key steps and results of the anti-VEGF treatment in the case study?

The case study showed that the patient received intravitreal injections of an anti-VEGF drug, bevacizumab. After just two injections, the granuloma showed significant regression and the patient's vision was considerably restored. Systemic steroids were gradually reduced, while anti-tubercular therapy was continued for the full six-month course.

What is optical coherence tomography (OCT), and why is it important in this context?

Optical coherence tomography (OCT) is a sophisticated imaging technique used to monitor the regression of tubercular granulomas and assess the response to anti-VEGF intravitreal injections. It provides detailed images of the optic nerve head, allowing doctors to visualize the granuloma and track changes in its size and structure over time. This helps in determining the effectiveness of the treatment and making informed decisions about patient care.

Is anti-VEGF the definitive treatment for tubercular eye granulomas? What further research is needed?

While the case study showed positive results using anti-VEGF intravitreal injections for tubercular granulomas, it's important to note that further research is needed. Additional studies can help to determine the optimal use of anti-VEGF therapy in treating ocular tuberculosis, including the best timing, dosage, and combination with other treatments. Also, more data is needed to evaluate the long-term efficacy and safety of this approach for different types of tubercular granulomas and patient populations. Investigating different types of anti-VEGF drugs for tubercular granulomas is an area for potential future research.