Clinical presentation, treatment, and outcomes in presumed intraocular tuberculosis: experience from Newcastle upon Tyne, UK

Abstract

Purpose To report the clinical manifestations and treatment outcomes of patients with presumed intraocular tuberculosis (TB) seen at the Newcastle Uveitis Service, Royal Victoria Infirmary, Newcastle upon Tyne, UK over a 10-year period. Methods Retrospective review of case notes. Results A total of 21 patients were identified. Occlusive retinal vasculitis was the commonest ophthalmological presentation (12 patients). Eight patients (38%) were found to have underlying active systemic TB (four with mediastinal lymphadenopathy, three with pulmonary TB, one with cutaneous TB). Constitutional or respiratory symptoms, elevated inflammatory markers, and an abnormal chest radiograph were poor indicators of active TB. Two patients had inactive intrathoracic TB. Eleven patients had latent TB. Eighteen patients received anti-tuberculous treatment. Final visual acuity was better than or equal to initial visual acuity in 14 out of 16 patients who completed at least 6 months of standard anti-tuberculous treatment. Conclusions Most patients with presumed intraocular TB have latent TB, but a significant minority has hitherto undetected active TB. Our series suggests that either proven or presumed intraocular TB occurs frequently in the absence of constitutional or respiratory symptoms, elevated inflammatory markers, or an abnormal chest radiograph. A minimum of 6 months standard anti-tuberculous treatment provides good visual outcomes in the majority of patients.

Anti-tubercular therapy for intraocular tuberculosis: A systematic review and meta-analysis

“…A total of 5 studies reported relevant history of previous TB (range 4.8%–11.1%) 45, 50, 62, 73, 76 , 7 studies on contact history of TB (range 12.1%–70.6%) 26,46,51,59,63,64,74 and 12 studies on presence of systemic TB (highest reported rate being 89.4% by Vos and colleagues 74 ). TST, QuantiFERON-TB Gold, and chest X ray were the more common adopted modalities of investigations with 10, 7, and 15 studies (of 28) using the aforementioned tests, respectively.…”

Liver failure following antituberculosis (ATT) chemotherapy for presumed tuberculous uveitis

“…We read with great interest the paper by Manousaridis et al, 1 which adds to the publication by Sanghvi et al, 2 with respect to presumed tuberculous (TB) uveitis in the United Kingdom, and we would commend both sets of authors for these well-presented case series. In the latter 2 it was recommended that a full 6-month course of Anti-TB therapy (ATT) be commenced in all patients with uveitis and latent TB, in whom other causes of uveitis have been ruled out.…”

Does the phthisioophthalmology section of our Ophthalmologic Society contribute in the promotion of quality care for patients with ocular tuberculosis?

“…Признавая, что отсутствие призна-ков и симптомов туберкулёза лёгких не исклю-чает диагноза туберкулёза глаз, данные авторы вполне обоснованно полагают, что врачам нужны диагностические признаки туберкулёза глаз, не-зависимые от внеглазных туберкулёзных пораже-ний [28]. Некоторые зарубежные авторы, однако, ставят диагноз предполагаемого туберкулёзного хориоретинита на основании положительного кожного туберкулинового теста и в соответствии с ним назначают лечение, в том числе и длитель-ное применение туберкулостатиков [26,29,31]. Обоснованность такого подхода к диагностике и лечению весьма сомнительна.…”