Purchase this article with an account.
Monique Munro, Arthur Chang, Ann-Marie Lobo, Pooja Bhat; Presumed Tuberculosis Uveitis: Diagnostic and therapeutic challenges. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5388.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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.
This PDF is available to Subscribers Only