June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Presumed Tuberculosis Uveitis: Diagnostic and therapeutic challenges
Author Affiliations & Notes
  • Monique Munro
    Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, Illinois, United States
  • Arthur Chang
    Medicine, University of Illinois in Chicago School of Medicine, Chicago, Illinois, United States
  • Ann-Marie Lobo
    Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, Illinois, United States
  • Pooja Bhat
    Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, Illinois, United States
  • Footnotes
    Commercial Relationships   Monique Munro, None; Arthur Chang, None; Ann-Marie Lobo, None; Pooja Bhat, None
  • Footnotes
    Support  1) Unrestricted Departmental Grant from Research to Prevent Blindness 2) NIH/NEI K12 EY021475 3) NIH/NCATS UL1TR002003
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 5388. doi:
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      Monique Munro, Arthur Chang, Ann-Marie Lobo, Pooja Bhat; Presumed Tuberculosis Uveitis: Diagnostic and therapeutic challenges. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5388.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Ocular tuberculosis (TB) creates a diagnostic dilemma and treatment challenge. Here we describe the presenting features, diagnostic and imaging findings and treatment approach of 4 TB uveitis patients in a non-endemic area.

Methods : Retrospective case series. The data collected included age, gender, laterality, location of ocular involvement, systemic findings, exposure history, time to diagnosis, duration of illness, visual acuity at presentation and at follow-up, examination findings, diagnostic and ophthalmic imaging findings and duration and response to treatment.

Results : 4 females, 54 to 84 years-of-age, were diagnosed with presumed TB-associated uveitis. One patient presented with bilateral anterior uveitis, two with anterior and intermediate uveitis and one with panuveitis and retinal vasculitis. All patients had positive QuantiFERON gold testing. PCR testing of ocular fluids was not pursued. Two patients had prior TB exposure and had immigrated from Nigeria and Mexico. Two patients were from the United States and one had received TB treatment as a child. Duration from onset, including prior to referral, to treatment initiation ranged from 4 to 18 months (mean: 9; median: 7). The course of anti-tuberculous systemic therapy ranged from 4 to 11 months (mean: 6.75; median: 6). Discontinuation was due to systemic intolerance. Despite the varying course of therapy, good visual outcomes were observed. Secondary inflammation was treated with oral and topical steroids. One patient required methotrexate.

Conclusions : Prior to referral, three patients were treated with long-term topical steroids for chronic uveitis. One patient had prior history of TB; but did not initially receive anti-TB therapy for presumed ocular TB as no pulmonary involvement was observed by the infectious disease specialist. Definitive diagnosis requires either demonstration of mycobacteria with acid-fast smear or growth on culture. PCR is not commonly done for diagnosing intraocular TB and positive/negative results may not influence management or treatment outcomes in a real-world scenario. Additionally, the duration of therapy remains unclear and there are no current established guidelines. Our report further demonstrates these challenges and reiterates the need for a collaborated diagnosis and treatment guideline for presumed ocular TB.

This is a 2020 ARVO Annual Meeting abstract.

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