Continuous progression of tubercular serpiginous-like choroiditis after initiating antituberculosis treatment

Am J Ophthalmol. 2011 Nov;152(5):857-63.e2. doi: 10.1016/j.ajo.2011.05.004. Epub 2011 Jul 26.

Abstract

Purpose: To describe the frequency, risk factors, management, and outcome of eyes with tubercular serpiginous-like choroiditis showing continued progression following initiation of antituberculosis treatment.

Design: Retrospective, comparative, interventional case series.

Setting: Institutional.

Patient population: One hundred ten patients of serpiginous-like choroiditis with 1) complete records, 2) tuberculin skin test, 3) active lesions in at least 1 eye, and 4) minimum 18 months follow-up.

Intervention: Based on the positivity of tuberculin skin test, the patients were categorized in Group A (84 patients with positive tuberculin test) and Group B (26 patients with negative tuberculin test). Of the 84 patients in Group A, 19 received systemic corticosteroids while 65 also received 4-drug antituberculosis treatment in addition. All patients in Group B received corticosteroids. Patients with continued progression received an increased dose of corticosteroids with or without immunosuppressive agents.

Main outcome measure: Development of continued progression.

Results: There were 61 men and 23 women in Group A and 19 men and 7 women in Group B. Continued progression was observed in 12 patients (14.28%) in Group A and none in Group B (P = .04). Of the 12 patients in Group A showing progression, 11 (16.9%) were receiving antituberculosis treatment and corticosteroids. The lesions responded in all eyes, and final visual acuity of 20/40 or better could be achieved in 10 eyes (75%).

Conclusion: Continued progression of choroiditis lesions occurs in 14% of patients after initiating antituberculosis treatment in tubercular serpiginous-like choroiditis. Increased immunosuppression with continuation of antituberculosis treatment resulted in good outcome.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents / therapeutic use*
  • Child
  • Choroiditis / drug therapy
  • Choroiditis / microbiology
  • Choroiditis / physiopathology*
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Tuberculin Test
  • Tuberculosis, Ocular / drug therapy
  • Tuberculosis, Ocular / microbiology
  • Tuberculosis, Ocular / physiopathology*
  • Visual Acuity / physiology
  • Young Adult

Substances

  • Antitubercular Agents
  • Glucocorticoids