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Annal D. Meleth, Wendy M. Smith, Nupura Krishnadev, Theresa Larson, Robert B. Nussenblatt, H Nida Sen; Characteristics Of PPD Positive Patients In A Tertiary Referral Center’S Uveitis Population. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3211.
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Determination of clinical characterstics and effect of immunosuppressive therapy on patients with a positive PPD and chronic uveitis in a tertiary referral clinic.
A Retrospective review of clinical records was performed on all patients with a documented positive PPD seen at the NEI uveitis clinic between November 2004 and May of 2010. Data recorded included demographics, anatomical location of uveitis, visual acuity, ocular inflammation grading, size of PPD, quantiferon status, history of BCG vaccination, history of therapy for PPD status, history of immunosuppressive therapy, and course of both immunosuppressive and anti-tuberculous therapy.
Thirty seven patients with a total of 33.3 person-years of follow-up were found with a positive PPD, primarily of african-american (45.9%), hispanic (21.6%), and asian (18.9%) backgrounds with an average age of 47 years old and a mean PPD size of 23 mm. Diagnoses associated with a positive PPD among our patients included all anatomical locations of uveitis with a preponderance of posterior or pan-uveitides (66.7%). Granulomatous uveitis was noted in slightly less than half of patients (46.7%). The majority of our PPD-positive patients were treated with anti-tuberculous therapy (87.5%), using either a multi-drug regimen or Isoniazid alone. The average PPD size was greater among patients treated with a multi-drug regimen vs. a single-agent (34 vs. 20mm) Quantiferon testing was positive in half of the PPD positive patients. Therapy for the majority of patients was managed at the NIH (72.3%). Immunosuppressive treatment did not have an adverse effect on disease course among PPD-positive patients with no worsening in ocular inflammatory scores noted during the period of therapy. The spectrum of uveitis therapy utilized in these patients included topical therapy in all patients, oral steroid (average dose 45 mg) or periocular injections in the majority of patients, and steroid-sparing immunosuppressive therapy in 27% of patients. Immunomodulatory agents used included cyclosporine, mycophenylate mofetil, methotrexate, azathioprine, infliximab, efalizumab, and daclizumab. The average visual acuity in the better seeing eye at the end of follow-up was 20/32.
PPD-positive patients with uveitis can present with a wide spectrum of clinical features. With concurrent anti-tuberculous therapy, immunomodulatory therapy does not appear to have an adverse effect on the course of ocular disease or presumed TB.
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