Abstract
Purpose: :
Tuberculosis is becoming increasingly common worldwide, and specifically, in our patient population. We describe the variety of ocular presentations and long term visual outcomes seen in both HIV+ and HIV– patients with uveitis secondary to TB.
Methods: :
Retrospective chart review performed to include the following data: patient demographics, presentation of ocular disease, immune status, initial and long–term visual acuities, treatment and complications.
Results: :
14 patients (21 eyes) were included in this cohort of patients with ocular manifestations of TB. There were 8 Hispanic patients, 3 African–Americans, 2 Asians and 1 Caucasian. Age ranged from 19 to 70, with a mean of 46, and a gender distribution of 8 males and 6 females. Three patients of the fourteen (21%) were HIV+. CD4 counts of HIV+ patients ranged from 46 to 480 at the time of presentation. Average follow–up was 9.9 months (range: 3 to 24 months). Initial visual acuities for the immunocompetent patients were between 20/25 and 20/200, and final between 20/20 and 20/150. Initial visual acuities for the HIV+ patients ranged from 20/20 to 20/40, and final from 20/20 to 20/60. Presentations included nodular scleritis, anterior uveitis, vitritis, panuveitis, retinal vasculitis, papillitis, serous retinal detachment, and choroidal granuloma. Not all patients had both a positive PPD and CXR. One patient had documented extrapulmonary TB. All patients were treated with 4 drug therapy for 6 to 9 months. One of the three HIV+ patients was on HAART at the time of presentation. Percentage of eyes responding to treatment was 94% in the immunocompetent group, and 66% in the HIV+ group. Complications included cataract, epiretinal membrane, and immune reconstitution syndrome.
Conclusions: :
In this series, the final visual acuity of patients with ocular manifestations of TB treated with 4 drug therapy was excellent, with 76% of immunocompetent eyes ≥ 20/50, and 41% ≥ 20/25 in long term follow up (mean 7.25 months). The final visual acuity of HIV+ patients was also excellent, with 50% of eyes ≥ 20/25 at the 12 month follow up point. Previous HAART therapy may impact on final visual acuity, although this was a small cohort. Our HIV + patients not on HAART therapy at the time of initiation of TB treatment developed more complications. Uveitis responded equally well in patients with or without documented pulmonary disease.
Keywords: microbial pathogenesis: clinical studies • clinical (human) or epidemiologic studies: outcomes/complications • inflammation