Choroidal involvement in presumed ocular tuberculosis: Report from a population in a low endemic area

Abstract

Purpose: We performed a retrospective, observational study to describe the epidemiology, clinical manifestations, treatment and outcome of choroidal involvement in TB in a tertiary care hospital in a low endemic area.

Methods: Seventy-seven patients with presumed TB associated choroidal lesions who underwent Quantiferon-TB Gold In Tube (QFT) test were included. Patients without choroidal involvement or with less than 6 months of follow-up were excluded. Treatment failure was defined as inability to taper oral corticosteroids to less than 10mg/day or topical steroids to less than twice a day, inability to stop oral immunosuppressive agents or persistence or recurrence of inflammation within the first six months of completion of antitubercular therapy (ATT). For the patients not on ATT, failure was defined by the inability to taper medications as above.

Results: Mean age was 45.5±15.7 years. Fourty-four (57.1%) were male, and 51 (66.2%) presented with bilateral disease. Thirty-nine patients were of Asian descent, 21 Caucasians and 17 Africans.<br /> Multifocal choroiditis was the most frequent clinical presentation (24 patients-31%), followed by serpiginous-like choroiditis (16 patients-21%), choroidal granuloma (16 patients-21%) and unifocal choroiditis (11 patients-14%). QFT was negative in 9 (12%), and indeterminate in 3.<br /> Fifty patients received ATT, 58 oral corticotherapy and 16 oral immunosupresants. ATT was given for 6 months to 22 patients, for 9 months to 5 and for 12 months to 23. Sixteen patients developed cystoid macular oedema at any point during the follow-up period. Sixteen developed glaucoma, 2 developed choroidal neovascular membranes, and 8 required cataract surgery.<br /> Binary logistic regression analysis correcting by age, sex and ATT revealed that a positive QFT decreased the risk of treatment failure (OR=0.09; p=0.020) and oral corticosteriods increased that risk (OR=17.87; p=0.017). No statistical association was found between ATT and failure rate(p=0.483) in the logistic regression model.

Conclusions: Multifocal choroiditis, choroidal tuberculoma and serpiginous-like choroiditis were the most common presentations.Treatment failure rates (i.e inablility to taper steroids) were equivalent between ATT and non ATT treated groups. Patients with positive QFT showed treatment failure less frequently, while those receiving oral corticotherapy had an increased risk of failure.