Ocular Signs Predictive of Tubercular Uveitis

Gupta, Amod; Bansal, Reema; Gupta, Vishali; Sharma, Aman; Bambery, P

doi:10.1016/j.ajo.2009.11.020

Cited by 212 publications

(153 citation statements)

References 31 publications

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“…In their series from India, Gupta et al 17 compared the presence of specific ocular findings between patients with presumed intraocular TB and patients with non-tubercular uveitis. 17 They found that if the presence of any one of broad-based posterior synechiae, retinal vasculitis with choroiditis, retinal vasculitis without choroiditis, and serpiginous-like choroiditis is used to diagnose intraocular TB, then only 14% of patients with intraocular TB are likely to be missed. In the same study, retinal vasculitis with choroiditis, retinal vasculitis without choroiditis, and serpiginous-like choroiditis were found to have high positive predictive values but low negative predictive values for the diagnosis of intraocular TB, making it difficult to rule out TB if these signs are absent.…”

Section: Discussionmentioning

confidence: 99%

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

Manousaridis

Ong

Stenton

et al. 2013

Eye

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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.

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Section: Discussionmentioning

confidence: 99%

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

Manousaridis

Ong

Stenton

et al. 2013

Eye

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“…This raises the question as to whether choroidal thinning in chronic granulomatous disease is localised to the macula region or more widespread, especially as granulomatous uveitis can present with diffuse posterior segment signs. 5,42,44 In a recent study, extra-macular scans performed in eyes diagnosed with birdshot chorioretinitis demonstrated generalised choroidal thinning outside the macula. 18 Although factors including age and disease activity were well matched between the good (o0.3 LogMAR) and poor (≥0.3 LogMAR) VA groups, other confounders are possible.…”

Section: The Choroid In Granulomatous Uveitismentioning

confidence: 98%

“…26 Most patients have no evidence of Mycobacterium tuberculosis in their ocular biopsies. 27 Patients with clinical ocular signs suggestive of TB, 5 and positive microscopy or culture of Mycobacterium tuberculosis from any bodily fluid, in the absence of another identifiable cause for their uveitis were labelled as definite ocular TB. In the absence of confirmatory microbiology, when other identifiable causes of uveitis had been excluded, patients were labelled as presumed ocular TB only if they met all of the following three published criteria: (1) ocular signs suggestive of TB 5 ; (2) positive QuantiFERON-TB Gold test [28][29][30][31][32] ; and (3) positive response to anti-tuberculous therapy.…”

Section: Diagnostic and Inclusion Criteriamentioning

confidence: 99%

“…1 It is characterised by clinical features including 'mutton-fat' keratic precipitates in the cornea, cells within the anterior chamber and vitreous, retinal vasculitis, and focal or diffuse choroidal lesions. [2][3][4][5] Granulomatous disease may result from either an autoimmune process, most commonly sarcoidosis, 2,3 or a systemic infection, usually tuberculosis (TB), 2,6,7 occurring either as an isolated ocular condition or as part of a wider systemic disease. 8 Sarcoid-and TB-associated granulomatous uveitis can cause visual disability from inflammatory sequelae such as cystoid macula oedema, glaucoma, or chorioretinal ischaemia.…”

Section: Introductionmentioning

confidence: 99%

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Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis

Mehta

Sim

Keane

et al. 2015

Eye

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Aim The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid-and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT). Methods Twenty-seven patients (27 eyes) diagnosed with sarcoid-(13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a sixmonth period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software. Results The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 ( = 140.71/95.72 μm)) compared with sarcoid uveitis (1.07 ( = 137.70/128.69 μm)) (P = 0.001). A thinner choroid was observed in eyes with a VA ≥ 0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR) = 147.0-253.4 μm) compared with those with VA o0.3 LogMAR (292.4 μm (IQR = 240.1-347.6 μm)) at the total macula circle (P = 0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR = 272.3-375.4 μm) in active compared with 239.3 μm (IQR = 195.3-330.9 μm) in quiescent disease (P = 0.04). Conclusion A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.

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“…Ipsilateral choroiditis in immunocompetent patients ('thumbprint lesions') following herpes zoster ophthalmicus (Supplementary Figure 2) does not progress to ARN, but is clearly related to the prior infection, perhaps as an immunologic host response. 4 Serpiginous choroidopathy is classified as a non-infectious uveitis, but there is a strong epidemiologic association with tuberculous infection and a serpiginous-like choroidopathy, 5,6 which could represent either direct choroidal infection or a hypersensitivity reaction to infection elsewhere. It has a different pattern of disease than classic serpiginous choroidopathy 7 or the classic choroidal granulomas and dense periphlebitis that are pathognomonic for tuberculous uveitis (Supplementary Figure 3).…”

Section: Diagnostic Challengesmentioning

confidence: 99%