Presumed tuberculous uveitis in a university-based tertiary referral center in Saudi Arabia

Int Ophthalmol. 2019 Feb;39(2):317-333. doi: 10.1007/s10792-017-0815-9. Epub 2018 Jan 9.

Abstract

Purpose: To describe clinical characteristics and outcomes of treatment in patients with presumed tuberculous uveitis (PTU).

Methods: All patients diagnosed with PTU between January 1996 and March 2013 were reviewed. The diagnosis was made when clinical findings were consistent with possible intraocular tuberculosis, strongly positive purified protein derivative (PPD) skin test result, and response to anti-tuberculous therapy with no other cause of uveitis as suggested by history, symptoms, or ancillary testing.

Results: Ninety patients (141 eyes) were identified. There were 43 males (47.3%) and 47 females (52.7%). Mean age was 48.2 ± 14.4 years. Mean duration of symptoms prior to presentation was 6.7 ± 8.3 months. Ten eyes (7.1%) had anterior uveitis, 18 eyes (12.8%) had intermediate uveitis, 34 eyes (24.1%) had posterior uveitis, and 79 eyes (56%) had panuveitis. Macular edema was present in 33.3% of the eyes at presentation. All patients received anti-tuberculous therapy and systemic corticosteroids. Mean follow-up after completion of therapy was 36 ± 2.5 months. Only 2 eyes developed recurrent inflammation after treatment completion. At last follow-up, all eyes showed resolution of inflammation, associated with significant improvement in visual acuity. There was a significant positive correlation between initial and final VA. Eyes that had macular edema at presentation showed a significant reduction in central macular thickness at final follow-up.

Conclusions: There is delay in presentation of patients with PTU. The most common anatomic diagnosis was panuveitis. Treatment with anti-tuberculous therapy combined with systemic corticosteroids resulted in resolution of inflammation and macular edema with significant improvement in visual acuity.

Keywords: Macular edema; Tuberculosis; Uveitis; Visual acuity.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use*
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / epidemiology*
  • Eye Infections, Bacterial / microbiology
  • Female
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Retrospective Studies
  • Saudi Arabia / epidemiology
  • Tertiary Care Centers / statistics & numerical data*
  • Treatment Outcome
  • Tuberculosis, Ocular / diagnosis
  • Tuberculosis, Ocular / drug therapy
  • Tuberculosis, Ocular / epidemiology*
  • Universities*
  • Uveitis / drug therapy
  • Uveitis / epidemiology*
  • Uveitis / microbiology
  • Young Adult

Substances

  • Antitubercular Agents
  • Glucocorticoids