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Oren Tomkins-Netzer, Belinda Leong, Xiaozhe Zhang, Susan Lightman, Peter J McCluskey; Anti-tuberculosis treatment reduces the risk of disease recurrence among eye with latent tuberculosis-related uveitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1141.
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The potential impact of latent tuberculosis (TB) on eyes with uveitis and no signs of active TB remains unclear. The aim of this study was to evaluate disease control and visual function in eyes with latent-TB related uveitis and compare the response to treatment between those receiving anti-TB treatment (ATT) and those not treated with ATT.
The study included uveitis patients with a positive interferone gamma assay but no evidence of active ocular or systemic TB or of having received ATT in the past. Such cases were defined as having latent TB-related uveitis. Disease activity and visual function were evaluated and compared between eyes of patients that received ATT together with their immunosuppression treatment and those that only received immunosuppression with no ATT. Generalized estimating equations analysis was used to study best corrected visual acuity (BCVA) changes. Multivariate Cox regression model was applied to investigate predictive factors of disease recurrence.
129 (199 eyes) with a diagnosis of latent TB related uveitis were included in the study. Of these, 89 patients (69%) ultimately received ATT together with their immunosuppression treatment. BCVA at presentation was 82.8±1.7 early treatment diabetic retinopathy study (ETDRS) letters and improved significantly by 4.5±1.4 letters (p=0.01) during a 60 month follow-up, with no difference between those receiving ATT and those who did not (change in BCVA 5.3±1.5 ETDRS letters vs. 3±3.1 letters respectively, p=0.16). Disease recurrence occurred among sixty-eight eyes (34.9%) with latent TB-related uveitis (0.64±0.08 recurrences per-year), with eyes of patients receiving ATT less likely to develop a recurrence compared to those not receiving ATT (29.5% vs. 48.2%, OR 0.47, 95% CI 0.29-0.77, p=0.003). Eyes treated with ATT recurred at an estimated median of 120 months compared with 51 months in eyes with no treatment (p=0.005).
Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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