Purchase this article with an account.
A. Nagpal, R.M. Lieberman, R.M. Fischer; Differences in Presentation and Outcome Among Immunocompromised and Immunocompetent Patients with Uveitis Secondary to Tuberculosis in an Indigent Clinic Population . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1901.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Tuberculosis is becoming increasingly common worldwide, and specifically, in our patient population. We describe the variety of ocular presentations and long term visual outcomes seen in both HIV+ and HIV– patients with uveitis secondary to TB.
Retrospective chart review performed to include the following data: patient demographics, presentation of ocular disease, immune status, initial and long–term visual acuities, treatment and complications.
14 patients (21 eyes) were included in this cohort of patients with ocular manifestations of TB. There were 8 Hispanic patients, 3 African–Americans, 2 Asians and 1 Caucasian. Age ranged from 19 to 70, with a mean of 46, and a gender distribution of 8 males and 6 females. Three patients of the fourteen (21%) were HIV+. CD4 counts of HIV+ patients ranged from 46 to 480 at the time of presentation. Average follow–up was 9.9 months (range: 3 to 24 months). Initial visual acuities for the immunocompetent patients were between 20/25 and 20/200, and final between 20/20 and 20/150. Initial visual acuities for the HIV+ patients ranged from 20/20 to 20/40, and final from 20/20 to 20/60. Presentations included nodular scleritis, anterior uveitis, vitritis, panuveitis, retinal vasculitis, papillitis, serous retinal detachment, and choroidal granuloma. Not all patients had both a positive PPD and CXR. One patient had documented extrapulmonary TB. All patients were treated with 4 drug therapy for 6 to 9 months. One of the three HIV+ patients was on HAART at the time of presentation. Percentage of eyes responding to treatment was 94% in the immunocompetent group, and 66% in the HIV+ group. Complications included cataract, epiretinal membrane, and immune reconstitution syndrome.
In this series, the final visual acuity of patients with ocular manifestations of TB treated with 4 drug therapy was excellent, with 76% of immunocompetent eyes ≥ 20/50, and 41% ≥ 20/25 in long term follow up (mean 7.25 months). The final visual acuity of HIV+ patients was also excellent, with 50% of eyes ≥ 20/25 at the 12 month follow up point. Previous HAART therapy may impact on final visual acuity, although this was a small cohort. Our HIV + patients not on HAART therapy at the time of initiation of TB treatment developed more complications. Uveitis responded equally well in patients with or without documented pulmonary disease.
This PDF is available to Subscribers Only