Intraocular tuberculosis

Abstract

Summary1Welve patients with a diagnosis of intraocular tuberculosis are described. Nine patients presented with florid ischaemic retinal vasculitis and a marked tendency to neovascularisation. 1Wo patients developed choroidal tubercles; iris nodules were observed in association with anterior uveitis in the remaining patient. The methods of diagnosis, management and possible mechanisms of pathogenesis of these differ ent clinical presentations are discussed.

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

“…In our series, occlusive retinal venous vasculitis was the most common ophthalmological finding, present in 12 patients (57%). Similarly, in the series of Rosen et al, 4 florid ischemic retinal vasculitis with a marked tendency to neovascularization was the most common ocular manifestation of intraocular TB and was observed in 9 out of 12 patients included in their study. We suggest that further evaluation for underlying systemic TB should be considered in all patients with occlusive retinal venous vasculitis in whom no other systemic association for this is present.…”

“…In our series, intraocular inflammation resolved without recurrence in all patients treated in this way. Although corticosteroid or immunosuppressive therapy may cause a re-activation of systemic TB resulting in severe disseminated TB and even a panophthalmitis, 4,26 we suggest that the presence of certain sight-losing complications, such as cystoid macular edema, or severe intraocular inflammation, justifies the use of corticosteroid treatment under the coverage of ATT. The route of administration of corticosteroids may be topical, periocular, or systemic.…”

“…Intraocular TB has not been separately quantified in surveillance data from the UK Health Protection Agency or the World Health Organization, and there have been very few case series of intraocular TB from UK centres. [4][5][6] We present the clinical manifestations and treatment outcomes of patients with presumed intraocular TB, seen in the Newcastle Uveitis Service over a 10-year period.…”

Tuberculose intraocular

“…Alguns autores relataram casos de vasculite retiniana, especificamente periflebite, concomitante com TB pulmonar, onde houve regressão do processo inflamatório intraocular e da vasculite, apenas com o uso do medicamento para TB, sem uso de corticóide. Estes autores têm a opinião que provavelmente estas vasculites são de etiologia infecciosa direta, em razão da melhora do quadro apenas com a instituição do tratamento antituberculoso (79) . O uso de corticosteróides tópicos está indicado nos casos de ceratoconjuntivite flictenular tuberculosa, uveíte anterior, esclerite e ceratite intersticial, principalmente nos casos onde o processo inflamatório na câ-mara anterior está bastante intenso, com risco de formação de sinéquias ou membranas inflamatórias, levando à seclusão ou oclusão pupilares, aumento ou diminuição acentuada da pressão intraocular.…”

Reply to Wakefield and Kumar

“…3 Moreover, administering corticosteroid or immunosuppressive therapy for severe intraocular inflammation without the coverage of ATT may cause re-activation of systemic TB, resulting in severe disseminating TB or even panophthamlitis. 4,5 In a large series of patients with presumed intraocular TB and latent TB combination treatment with corticosteroids and ATT reduced the risk of developing recurrence of the uveitis by approximately two-thirds compared to Correspondence treatment with corticosteroids alone. 6 Based on the above and on the results of our study, we stated that a minimum of 6 months standard ATT is generally justified in patients with presumed intraocular TB and latent TB.…”