Presumed tuberculous uveitis in a university-based tertiary referral center in Saudi Arabia
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To describe clinical characteristics and outcomes of treatment in patients with presumed tuberculous uveitis (PTU).
All patients diagnosed with PTU between January 1996 and March 2013 were reviewed. The diagnosis was made when clinical findings were consistent with possible intraocular tuberculosis, strongly positive purified protein derivative (PPD) skin test result, and response to anti-tuberculous therapy with no other cause of uveitis as suggested by history, symptoms, or ancillary testing.
Ninety patients (141 eyes) were identified. There were 43 males (47.3%) and 47 females (52.7%). Mean age was 48.2 ± 14.4 years. Mean duration of symptoms prior to presentation was 6.7 ± 8.3 months. Ten eyes (7.1%) had anterior uveitis, 18 eyes (12.8%) had intermediate uveitis, 34 eyes (24.1%) had posterior uveitis, and 79 eyes (56%) had panuveitis. Macular edema was present in 33.3% of the eyes at presentation. All patients received anti-tuberculous therapy and systemic corticosteroids. Mean follow-up after completion of therapy was 36 ± 2.5 months. Only 2 eyes developed recurrent inflammation after treatment completion. At last follow-up, all eyes showed resolution of inflammation, associated with significant improvement in visual acuity. There was a significant positive correlation between initial and final VA. Eyes that had macular edema at presentation showed a significant reduction in central macular thickness at final follow-up.
There is delay in presentation of patients with PTU. The most common anatomic diagnosis was panuveitis. Treatment with anti-tuberculous therapy combined with systemic corticosteroids resulted in resolution of inflammation and macular edema with significant improvement in visual acuity.
KeywordsUveitis Tuberculosis Macular edema Visual acuity
The authors thank Ms. Connie Unisa-Marfil for secretarial assistance. This work was supported by King Saud University through Vice Deanship of Research Chair (Dr. Nasser Al-Rashid Research Chair in Ophthalmology [AMA]), Riyadh, Saudi Arabia.
Compliance with ethical standards
Conflict of interest
The authors declare that they do not have any conflict of interest on the content of manuscript and study undertaken.
- 2.World Health Organisation. Tuberculosis Fact Sheet 2015. World Health Organization; 2016. http://www.who.int/mediacentre/factsheets/fs104/en/. Accessed 21 November 2016
- 3.Centers for Disease Control (USA). Tuberculosis—Data and Statistics 2015. http://www.cdc.gov/tb/statistics/default.htm. Accessed 21 November 2017
- 20.Singh R, Gupta V, Gupta A (2004) Pattern of uveitis in a referral eye clinic in north India. Indian J Ophthalmol 52:121–125Google Scholar
- 24.Kaimbo Wa Kimbo D, Bifuko A, Dernouchamps JP, Missotten L (1998) Chronic uveitis in Kinshasa (D R Congo). Bull Soc Belge Ophtalmol 270:95–100Google Scholar
- 27.Rodriguez A, Calonge M, Pedroza-Seres M, et al (1996) Referral patterns of uveitis in a tertiary eye care center. Arch Ophthalmol (Chicago, Ill 1960) 114:593–599Google Scholar
- 36.Sarvananthan N, Wiselka M, Bibby K (1998) Intraocular tuberculosis without detectable systemic infection. Arch Ophthalmol (Chicago, III 1960) 116:1386–1388Google Scholar
- 40.Abu El-asrar A, Abouammoh M, Al-mezaine HS (2009) Tuberculous uveitis. Middle East Afr J Ophthalmol 16:188–201Google Scholar
- 46.Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature (SUN) Working Group (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 140(3):509–516Google Scholar
- 47.Rowland K, Guthmann R, Jamieson B, Malloy D (2006) Clinical inquiries. How should we manage a patient with a positive PPD and prior BCG vaccination? J Fam Pract 55:718–720Google Scholar
- 49.Llorenç V, González-Martin J, Keller J et al (2013) Indirect supportive evidence for diagnosis of tuberculosis-related uveitis: from the tuberculin skin test to the new interferon gamma release assays. Acta Ophthalmol 91:99–107. https://doi.org/10.1111/j.1755-3768.2012.02564.x CrossRefGoogle Scholar
- 53.Khochtali S, Gargouri S, Abroug N et al (2015) The spectrum of presumed tubercular uveitis in Tunisia, North Africa. Int Ophthalmol 35:663–671Google Scholar
- 55.Gineys R, Bodaghi B, Carcelain G et al (2011) QuantiFERON-TB gold cut-off value: implications for the management of tuberculosis-related ocular inflammation. Am J Ophthalmol 152(433–440):e1Google Scholar
- 64.Alaraj AM, Al-Dhibi H, Al-Mezaine HS, Abu El-Asrar AM (2013) Solitary presumed choroidal tuberculomas masquerading as choroidal tumors. Saudi Med J 34:86–90Google Scholar
- 71.Bansal R, Gupta A, Gupta V, Dogra MR, Bambery P, Arora SK (2008) Role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis. Am J Ophthalmol 146(772–779):e2Google Scholar
- 72.Agarwal A, Handa S, Aggarwal K, Sharma M, Singh R, Sharma A, Agrawal R, Sharma K, Gupta V (2017) The role of dexamethasone implant in the management of tubercular uveitis. Ocul Immunol Inflamm. https://doi.org/10.1080/09273948.2017.1400074. [Epub ahead of print]
- 73.Jain L, Panda KG, Basu S (2017) Clinical outcomes of adjunctive sustained-release intravitreal dexamethasone implants in tuberculosis-associated multifocal serpigenoid choroiditis. Ocul Immunol Inflamm. https://doi.org/10.1080/09273948.2017.1383446. [Epub ahead of print]