Abstract
Purpose :
Austria belongs to the TB low incidence countries with 7,3/100.000 cases per year. Although numbers dropped from 2005 to 2014, there is a slight increase of cases since the big migration waves 2015/2016. The purpose of this study is to report symptomatic ocular tuberculosis cases in refugees previously screened negative for TB.
Methods :
The case series includes 3 male HIV negative subjects aged 18 to 33 years. They were screened for active tuberculosis upon arrival in different refugee centers and were found negative. 3 to 12 months later they reported progressive visual deterioration. Not until referral to uveitis specialist ocular TB was considered and the subjects remained untreated for several months with further visual loss. Reevaluation of TB activity revealed highly positive Quantiferon-TB gold tests and positive chest x ray in 2. Patients received standard six-month regimen of antituberculosis therapy. In 2 patients oral steroids were added later in the course. Ophthalmological assessments were done at the beginning, regularly during and at the end of therapy.
Results :
Tuberculous uveitis was diagnosed in all 3 cases. Clinical presentation comprised serpiginous-like choroiditis (2) and multifocal choroiditis and retinal vasculitis with neovascularization (1). Keratic precipitates, anterior segment cells, flaring, vitritis and macular edema had resolved at the end of treatment. Posterior uveitis was controlled in all 3 cases.
Conclusions :
Ocular TB is an unusual and perhaps underdiagnosed entity in refugees from high endemic countries. To improve timely diagnosis, refugee centers, physicians screening migrants and general ophthalmologists should be informed and educated abouth this widely unknown extrapulmonary TB type in order to save eyes from visual impairment. Post-migration follow-up of those deemed to be at an increased risk of developing TB, especially individuals staying at crowded refugee camps, should be implemented.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.