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Samuel Ravi Choudhury, Stephen C B Teoh; Ocular Tuberculosis: Spectrum of Presentations, Diagnosis and Management in An Endemic Developed Country. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1559.
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To determine the clinical characteristics of ocular tuberculosis in a multi-ethnic society, in which tuberculosis (TB) is endemic.
This is a retrospective descriptive case series of one hundred and eighty five patients, who presented to the department of ophthalmology, Tan Tock Seng Hopsital, Singapore over a 13 year period from April 2000 to May 2013. Patients were included if they fulfilled the following criteria: Any ocular signs or symptoms with any of the following: 1. Chest x-ray findings suggestive of TB 2.Positive Acid-fast bacilli smear 3.Positive Interferon-gamma release assays 4.Positive Mantoux test (TST>10mm) 5.Positive aqueous humor polymerase chain reaction test. We were more inclusive given the endemic nature of tuberculosis in our population. Patients were excluded if they tested positive for other conditions.
The mean age of our patients was 47.30 ± 16.30 years. Most were Chinese (56.22%) and male (58.92%). Chinese patients present at 52.12 ± 16.41 years with Indians and Malays having an earlier presentation at mean age of 44.1 ± 15.43 and 43.64 ± 12.52 respectively. Location of pathology was distributed over 4 main anatomical sites. 50.3% of the presentations were in the anterior segment, 9.8% in the middle segment, 14.0% in the posterior segment, 18.1% spanned all 3 segments and 7.8% on the sclera (n=195). With each incremental year for age, the odds of having intermediate, posterior and panuveitis decreases by 1-3% as compared to anterior uveitis. The most common signs on physical examination are cells (85.9%), keratic precipitates (61.1%) and conjunctiva congestion (58.9%). 125 patients (67.6%) complained of red eyes, 65.4% with blurriness of vision and 51.9% with eye pain. The odds of the presence of retrolental cells, vitreous haze, retinal vasculitis and snowbanking have been identified to significantly differ between at least 2 racial groups. Malay patients had 4.62 times the odds of having vitritis as compared to Chinese patients.
The clinical presentation of ocular tuberculosis in a multi-ethnic TB endemic country differs from the countries previously described. The current suggested diagnostic criteria could be broaden to include other presentations to increase the sensitivity. Further studies could also investigate race as a potential confounder in the presentation of ocular tuberculosis.
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