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Erick Rebolledo Enríquez, Roberto Dalli, Rosalva Bobadilla, Miguel Pedroza-Seres; Clinical manifestations and diagnosis challenge of ocular tuberculosis in Mexican population. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2353.
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© ARVO (1962-2015); The Authors (2016-present)
To describe clinical manifestations of patients diagnosed with ocular tuberculosis in a reference Centre in Mexico City
We analyzed medical records from patients diagnosed with ocular tuberculosis from January 2004 to December 2014 in Uveitis and Immunology department including demographic data, clinical presentation, treatment and complication
4493 patients were seen at the service; 1.24% (75 eyes) had the diagnosis of ocular tuberculosis. The presentation among the genders was 52% in women vs 48% in men, with a mean age of 46 years at diagnosis. We had a mean follow-up of 18.25 months. The chief complain at the onset of symptoms were: decrease vision (57%), red eye (21%) and ocular pain (11%). We observed a right eye predilection (65%), and 33% of bilateral cases. The clinical presentation was: panuveitis (39%), anterior uveitis (20%), posterior uveitis (16%), scleritis (10%), and others (15%). BCVA was logMAR 0.6020 or higher in 41% at first visit. Main diagnostic tests used were: PCR of aqueous humor in 11%, Quanti-FERON-TB Gold in 36% and PPD in 55 % of patients. 75% of positive PPD patients had an induration between 10 and 30 mm, and > 30 mm in 25%. According to clinical manifestations and auxiliary tests, presumptive and confirmed cases were 89.3% and 10.7% respectively. Regarding treatment, isoniazid monotherapy was the most used regimen (38%), followed by rifampicin/isoniazid/pyrazinamide/ethambutol therapy (36%), and a double or triple regimen in 26% of patients.At the last visit, 60% of positive Quanti-FERON-TB Gold patients, treated with antifimic drugs improved inflammatory activity. BCVA was improved or stabilized in all cases, whereas all positive cases who did not received antifimic treatment had 2 lines drop in their BCVA. Patients with positive PPD test treated with antifimic drugs improved inflammatory activity in 67%, and improved or stabilized BCVA in 68% of cases. Complications were present in 55% of cases, the most common include: cataract in 25 eyes, ocular hypertension in 12, and cystoid macular edema in 6 eyes.
Ocular tuberculosis is an uncommon cause of morbidity. Lack of specific clinical manifestations, uniform criteria and high specific tests in developing countries can lead to misdiagnosis and delay in management. Cultural and economic factors play an important role in ocular tuberculosis approach, leading to a higher rate of complication
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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