Abstract
Purpose :
Tuberculous uveitis is a diagnostic and therapeutic conundrum. We report the demographics, clinical features of patients with presumed tuberculosis-related uveitis (TBU) in Singapore, and aim to analyse the treatment outcome of patients on anti-tubercular therapy (ATT) and corticosteroid therapy, as well as determine the factors predictive of treatment failure.
Methods :
We performed a retrospective analysis of patients with presumed TBU at a tertiary referral eye care centre in Singapore between 2007 and 2012. All patients had a minimum follow-up of 12 months, and our main outcome measure was a failure of complete resolution of the uveitis or recurrence of inflammation at 12 and 24 months post commencement of treatment.
Results :
Fifty-three patients were included with a mean age of 44.18 ± 15.26 years and 54.72% were males. Nineteen (35.85%) patients had bilateral involvement with panuveitis and anterior uveitis being the most common presentations. Thirty-six (67.92%) patients received ATT of which 8 received concurrent ATT and systemic steroids. Of the 17 (32.08%) patients that did not receive ATT, 5 received systemic steroids in addition to their topical steroids. Eleven (20.75%) patients in the ATT group and 3 (27.27%) patients in the non-ATT group had treatment failure at 12 months (p = 0.511) while 6 patients had treatment failure at 24 months ( p= ) . The clinical phenotypes of uveitis and having a combination of positive tuberculin skin test, chest radiographic imaging or interferon gamma release assays also had no impact on the treatment outcome.
Conclusions :
ATT may not have a statistically significant impact in improving treatment success in patients with presumed TBU. There were no significant predictive factors for treatment failure and chest imaging is recommended as a routine investigation for a uveitic workup. A large-scale, multi-centre, prospective study is advised to devise an appropriate treatment guideline for TBU.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.