June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Choroidal involvement in presumed ocular tuberculosis: Report from a population in a low endemic area
Author Affiliations & Notes
  • Ioanna Triantafyllopoulou
    NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Julio José González-López
    NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Bhaskar Gupta
    Royal Devon and Exeter NHS trust, Exeter, United Kingdom
  • Farzana Rahman
    NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Peter Addison
    NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Mark C Westcott
    NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Carlos Pavesio
    NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Rupesh Agrawal
    NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
    National Healthcare Group Institute Tan Tock Seng Hospital, Singapore, Singapore
  • Footnotes
    Commercial Relationships Ioanna Triantafyllopoulou, None; Julio González-López, None; Bhaskar Gupta, None; Farzana Rahman, None; Peter Addison, None; Mark Westcott, None; Carlos Pavesio, None; Rupesh Agrawal, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 5771. doi:https://doi.org/
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      Ioanna Triantafyllopoulou, Julio José González-López, Bhaskar Gupta, Farzana Rahman, Peter Addison, Mark C Westcott, Carlos Pavesio, Rupesh Agrawal; Choroidal involvement in presumed ocular tuberculosis: Report from a population in a low endemic area. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5771. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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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.

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