To study the outcome of latent tubercular uveitis (LTBU) treated with antitubercular therapy (ATT) combined or not with adjuvant systemic corticosteroids.
Methods:
Twenty patients (27 eyes) with LTBU were included in a monocentric retrospective study and evaluated for the absence of active disease after treatment. Data on the clinical outcomes (active inflammation), vision (best-corrected visual acuity, BCVA) and treatment were collected retrospectively.
Results:
Fourteen patients received ATT alone and six patients received ATT combined with systemic corticosteroids. The two groups were not comparable in terms of proportion of tubercular panuveitis cases and initial BCVA (59.3 ± 8.2 letters vs 44.2 ± 15.2 letters). There was no significant difference in remission rate and in BCVA between both groups 3 months after ATT discontinuation.
Conclusion:
Patients with LTBU treated with ATT alone had visual and inflammatory outcomes at least comparable to those of patients treated with ATT combined with systemic corticosteroids.
de SmetMDTaylorSRJBodaghiB, et al. Understanding uveitis: the impact of research on visual outcomes. Prog Retin Eye Res2011; 30: 452–470.
2.
MiserocchiEFogliatoGModoratiG, et al. Review on the worldwide epidemiology of uveitis. Eur J Ophthalmol2013; 23: 705–717.
3.
TsiroukiTDastiridouASymeonidisC, et al. A focus on the epidemiology of uveitis. Ocul Immunol Inflamm2018; 26: 2–16.
4.
JonesNP.The Manchester Uveitis Clinic: the first 3000 patients—epidemiology and casemix. Ocul Immunol Inflamm2015; 23: 118–126.
5.
LlorençVMesquidaMSainz de la MazaM, et al. Epidemi-ology of uveitis in a Western urban multiethnic population. The challenge of globalization. Acta Ophthalmol (Copenh)2015; 93: 561–567.
SheaKMKammererJSWinstonCA, et al. Estimated rate of reactivation of latent tuberculosis infection in the United States, overall and by population subgroup. Am J Epidemiol2014; 179: 216–225.
8.
GuptaVGuptaARaoNA.Intraocular tuberculosis – an update. Surv Ophthalmol2007; 52: 561–587.
9.
MercantiAParoliniBBonoraA, et al. Epidemiology of endogenous uveitis in north-eastern Italy. Analysis of 655 new cases. Acta Ophthalmol Scand2001; 79: 64–68.
10.
CutrufelloNJKarakousisPCFishlerJ, et al. Intraocular tuberculosis. Ocul Immunol Inflamm2010; 18: 281–291.
11.
AngMCheeS-P.Controversies in ocular tuberculosis. Br J Ophthalmol2017; 101: 6–9.
12.
SudheerBLalithaPKumarAL, et al. Polymerase chain reaction and its correlation with clinical features and treatment response in tubercular uveitis. Ocul Immunol Inflamm2018; 26: 845–852.
13.
AngMVasconcelos-SantosDVSharmaK, et al. Diagnosis of ocular tuberculosis. Ocul Immunol Inflamm2018; 26: 208–216.
14.
GuptaASharmaABansalR, et al. Classification of intraocular tuberculosis. Ocul Immunol Inflamm2015; 23: 7–13.
15.
HeidenDSaranchukPKeenanJD, et al. Eye examination for early diagnosis of disseminated tuberculosis in patients with AIDS. Lancet Infect Dis2016; 16: 493–499.
16.
WroblewskiKJHidayatAANeafieRC, et al. Ocular tuberculosis: a clinicopathologic and molecular study. Ophthalmology2011; 118: 772–777.
17.
American Thoracic Society, CDC, Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recomm Rep2003; 52: 1–77.
18.
Dyrhol-RiiseAMGranGWentzel-LarsenT, et al. Diagnosis and follow-up of treatment of latent tuberculosis; the utility of the QuantiFERON-TB gold in-tube assay in outpatients from a tuberculosis low-endemic country. BMC Infect Dis2010; 10: 57.
19.
ChungCYLiKKW. The efficacy of latent tuberculosis treatment for immunocompetent uveitis patients with a positive T-SPOT.TB test: 6-year experience in a tuberculosis endemic region. Int Ophthalmol2018; 38: 2273–2282.
20.
AgrawalRGunasekeranDVGrantR, et al. Clinical features and outcomes of patients with tubercular uveitis treated with antitubercular therapy in the Collaborative Ocular Tuberculosis Study (COTS)-1. JAMA Ophthalmol2017; 135: 1318–1327.
21.
Tomkins-NetzerOLeongBCSZhangX, et al. Effect of antituberculous therapy on uveitis associated with latent tuberculosis. Am J Ophthalmol2018; 190: 164–170.
22.
KeeARGonzalez-LopezJJAl-HityA, et al. Anti-tubercular therapy for intraocular tuberculosis: a systematic review and meta-analysis. Surv Ophthalmol2016; 61: 628–653.
23.
LouSMMontgomeryPALarkinKL, et al. Diagnosis and treatment for ocular tuberculosis among uveitis specialists: the international perspective. Ocul Immunol Inflamm2015; 23: 32–39.
24.
LouSMLarkinKLWinthropK, et al. Lack of consensus in the diagnosis and treatment for ocular tuberculosis among uveitis specialists. Ocul Immunol Inflamm2015; 23: 25–31.
25.
PatelSSSaraiyaNVTesslerHH, et al. Mycobacterial ocular inflammation: delay in diagnosis and other factors impacting morbidity. JAMA Ophthalmol2013; 131: 752–758.
26.
AngMWongWLKiewSY, et al. Prospective head-to-head study comparing 2 commercial interferon gamma release assays for the diagnosis of tuberculous uveitis. Am J Ophthalmol2014; 157: 1306–1314; 1314.e1–e4.
27.
AgrawalRAgarwalAJabsDA, et al. Standardization of nomenclature for ocular tuberculosis – results of Collaborative Ocular Tuberculosis Study (COTS) workshop. Ocul Immunol Inflamm. Epub ahead of print December2019. DOI: 10.1080/09273948.2019.1653933.
28.
JabsDANussenblattRBRosenbaumJT, et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol2005; 140: 509–516.
KrassasNWellsJBellC, et al. Presumed tuberculosis-associated uveitis: rising incidence and widening criteria for diagnosis in a non-endemic area. Eye (Lond)2018; 32: 87–92.
31.
AngLKeeAYeoTH, et al. Treatment outcome in patients with presumed tubercular uveitis at a tertiary referral eye care centre in Singapore. Int Ophthalmol2018; 38: 11–18.
32.
ZhangMZhangJLiuY.Clinical presentations and therapeutic effect of presumed choroidal tuberculosis. Retina2012; 32: 805–813.
33.
OrayMAbu SamraKEbrahimiadibN, et al. Long-term side effects of glucocorticoids. Expert Opin Drug Saf2016; 15: 457–465.
34.
YeeDValiquetteCPelletierM, et al. Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis. Am J Respir Crit Care Med2003; 167: 1472–1477.
35.
AwofesoN.Anti-tuberculosis medication side-effects constitute major factor for poor adherence to tuberculosis treatment. Bull World Health Organ2008; 86: B–D.
36.
McAllisterWAThompsonPJAl-HabetSM, et al. Rifampicin reduces effectiveness and bioavailability of prednisolone. Br Med J (Clin Res Ed)1983; 286: 923–925.
37.
La Distia NoraRvan VelthovenMEJTenDam-vanLoonNH, et al. Clinical manifestations of patients with intraocular inflammation and positive QuantiFERON-TB gold in-tube test in a country nonendemic for tuberculosis. Am J Ophthalmol2014; 157: 754–761.
38.
AngMHedayatfarAWongW, et al. Duration of anti-tubercular therapy in uveitis associated with latent tuberculosis: a case-control study. Br J Ophthalmol2012; 96: 332–336.
39.
BansalRGuptaAGuptaV, et al. Tubercular serpiginous-like choroiditis presenting as multifocal serpiginoid choroiditis. Ophthalmology2012; 119: 2334–2342.
40.
KawaliAEmersonGGNaikNK, et al. Clinicopathologic features of tuberculous serpiginous-like choroiditis. JAMA Ophthalmol2018; 136: 219–221.
