Mode of Presentations and Management of Presumed Tuberculous Uveitis at a Referral Center


ABSTRACT:BACKGROUND: The diagnosis of tuberculous uveitis is often presumptive, because of the difficulty in obtaining microbiological evidence. The diagnosis has to rely on characteristic ocular findings, and possibly a therapeutic treatment trial. OBJECTIVE: To illustrate the mode of presentations and management of presumed tuberculous uveitis at a referral eye center in Iraq.METHOD AND SUBJECTS:This prospective case series study included patients with presumed ocular tuberculosis presented consecutively at uveitis clinic/ Ibn Al-Haetham teaching eye hospital, from January 2007-January 2013. Ocular tuberculosis was presumed when findings were consistent with possible intraocular tuberculosis, intractable to steroid therapy, and no clinical or laboratory evidence for other causes of uveitis. Strongly positive tuberculin skin test result (more than14 mm area of induration/necrosis) supported the diagnosis, but was not a prerequisite for initiating therapy. All patients were treated with anti tuberculosis therapy. Clinical findings and response on treatment were documented in a special follow up cards.RESULTS: 64 patients with presumed TB uveitis were included in this study. Mean age of the patients was 35.7 years with no significant sex predominance. Majority of patients were from urban places (79.7%). Bilateral involvement was recorded in 62 patients. Vitritis was a universal finding, while multifocal choroiditis was the most common fundus lesions (104 eyes; 82.5%). All patients responded well to anti tuberculosis therapy. Systemic corticosteroids were added after few days in 14 patients to decrease inflammatory reaction, retinal vasculitis, macular edema and macular scaring. CONCLUSION: According to this study; vitritis with multifocal choroiditis is the most common mode of presentation in patients with presumed TB uveitis. All cases responded well to anti-tuberculosis therapy, systemic corticosteroids can be added to decrease inflammatory reaction, retinal vasculitis, macular edema and macular scaring.