Clinical Characteristics Of Tuberculous Uveitis And Antituberculous Therapeutic Effect

Purpose: To summarize the clinical data of tuberculous uveitis cases treated at the Uveitis and Ocular Immune department of the Tianjin Medical University Eye Hospital(TMUEH)in recent years,to explore the clinical characteristics of tuberculous uveitis and evaluate the anti-tuberculous treatment effect,thereby to improve the understanding of the disease and provide the basis for the diagnosis and treatment of tuberculous uveitis in the future.Methods: This is a retrospective case series of 18 patients(25 eyes)diagnosed as tuberculous uveitis at the Uveitis and Ocular Immune department of the TMUEH from January 2012 to December 2018.The Clinical data are Including tuberculosis(TB)related exposure history,disease history;TB-related laboratory tests: Tuberculin purified protein derivative(PPD),Interferon-γ release assays(IGRAs).TB-related radiological tests,history of eye diseases in patients and ocular signs and examinations including: vision,intraocular pressure,slit lamp microscopy examination,fundus photography,fundus fluorescence angiography(FFA),indocyanine green angiography(ICGA),Optical Coherence Tomography(OCT),etc.By analyzing these data,the clinical characteristics of patients with tuberculous uveitis were summarized.Paired t test was used to analyze the changes of vision and recurrence before and after antituberculosis treatment.Results: Among the 18 patients,5 were males and 13 were females,aged 22-67 years,with an average age of 45.94±15.61 years.The onset age of 5(27.8%)patients is less than 30 years and 10(55.6%)is more than 50 years.Among these patients,only 6 had a history of systemic TB(3 active TB and 3 preious disease).All the 18 patients were conducted PPD test after treatment.3 patients were generally positive;4 patients were moderate positive;11 cases were strongly positive,In addition to the red halo indentation,3 cases had local blisters and necrosis.The diameter of the red halo and indentatio was greater than or equal to15 mm in 14 patients(77.8%).Five of these patients were conducted IGRAs test.1 case was negative,and 4 cases showed an increase results consistented with PPD test.The mainly symptoms are visual impairment and floaters.The types of uveitis were posterior uveitis in 15 eyes(68.0%),followed by panuveitis in 5 eyes(24.0%),intermediate uveitis in 2 eyes(8.0%).The common fundus manifestations of patients were retinal vasculitis in 11 patients(61.1%),followed by focal retinochorioditis and choroidal tuberculosis.Retinal vasculitis is mainly bilateral,involving the middle and peripheral blood vessels.Papilloedema were found in 14 eyes(77.8%),macular edema in 14 eyes(77.8%),and severe vitreous inflammation in 8 eyes(44.4%).After the proposed diagnosis of tuberculous uveitis,the patients were given a combination of anti-tuberculosis and hormone therapy,with an average follow-up of 8.4 months.The inflammation in the eyes of the patients was relieved and the visual acuity was significantly improved in 18 eyes and reduced or without any change in 6 eyes.The paired t test was used to compare the Log Mar vision of patients before and after anti-tuberculosis treatment.The results showed that the vision of the patients was significantly improved after anti-tuberculosis treatment and the difference was statistically significant(0.02<P<0.05).Repeated episodes of ocular inflammation occurred in 9 eyes(mean 2.78 ±0.73)before starting anti-tuberculosis drugs.After anti-tuberculosis treatment,No recurrence was found during the follow-up period.Conclusion: The most common type of tuberculous uveitis is posterior uveitis.The common manifestations of fundus are retinal vasculitis,focal choroidal inflammation and choroidal granuloma.The retinal vasculitis commonly involves both eyes and is often accompanied with serious vitreous inflammation,papilloedemaand macular oedema.As for the diagnosis of tuberculous uveitis,auxiliary examinations,including PPD(especially the diameter of the indenture is more than 15mm),interferon release assay(IGRAs),and TB-related radiography,are of great significance.To recognize the clinical features of tuberculous uveitis,to inquire about the medical history,and to screen TB infection with laboratory examinations are important measures to reduce the misdiagnosis of tuberculous uveitis.After the proposed diagnosis,timely treatment against tuberculosis is important to improve vision and reduce recurrence.