Retina-Vitreous
2016 , Vol 24 , Num 2
Current Approachesin Diagnosis and Treatment of Ocular Tuberculosis: A Case Series and Literature Review
1M.D. Associate Professor, Ulucanlar Eye Training and Research Hospital, Ankara/TURKEY2M.D. Asistant, Ulucanlar Eye Training and Research Hospital, Ankara/TURKEY The diagnosis of ocular tuberculosis is still challenging due to lack of consensus in diagnostic criteria and clinical characteristics mimicking a number of ocular inflammatory diseases. Moreover, there is no standard treatment regimen or length of therapy for ocular tuberculosis. In this study, clinical characteristics and treatment results of 10 cases diagnosed as ocular tuberculosis between 2010 and 2015 are summarized and 3 of them are described in details. Seven patients were diagnosed as presumed ocular tuberculosis with the presence of ocular findings suggesting tubercular uveitis, exclusion of other uveitic entities and positive interferon-γ release assay and/or tuberculin skin test. Two patients were associated with pulmonary disease and one with lymphadenitis. The mean age at presentation was 31.6 and 70% of patients were male. Granulomatous uveitis was observed in 60%. Multifocal choroiditis and retinal vasculitis were the most commonly observed ocular findings (4 patients each). All but one patient were treated with conventional quadruple anti-tubercular therapy (ATT) for the first 2 months followed by 2 drugs for 7-12 months. Paradoxical worsening (Jarisch-Herxheimer reaction) which could be controlled with systemic or periocular corticosteroids was observed in 2 patients (20%). In 8 patients in whom the ATT was finalized, uveitis did not recur following the treatment.
In this paper, we also aimed to discuss current classification, diagnostic criteria and therapeutic approaches of ocular tuberculosis and review the literature.
Keywords : Tuberculosis, ocular tuberculosis, diagnosis, treatment