Effect of Antituberculous Therapy on Uveitis Associated With Latent Tuberculosis

Am J Ophthalmol. 2018 Jun;190:164-170. doi: 10.1016/j.ajo.2018.03.032. Epub 2018 Mar 29.

Abstract

Purpose: To describe the clinical features of patients with uveitis associated with latent tuberculosis (TB) and examine the effect of anti-TB treatment (ATT) on uveitis outcome.

Design: Retrospective cohort study.

Methods: One hundred ninety-nine eyes of 129 patients diagnosed with uveitis associated with latent TB were evaluated for recurrence of disease following treatment. Eighty-nine of the patients (69%) received ATT and information was gathered retrospectively regarding clinical outcome, vision, and treatment. Outcome measures included best-corrected visual acuity (BCVA) and rate of disease recurrence.

Results: This study included 89 patients (69%) who received ATT and 40 patients who did not. The uveitis was treated with local and systemic anti-inflammatory and immunosuppressive therapy in all patients. The mean change in BCVA following treatment was 4.5 ± 1.4 letters over the follow-up period, with no difference between eyes of patients receiving ATT and those who did not. Sixty-eight eyes (34.9%) had a recurrence of uveitis (0.64 ± 0.08 recurrences per year), with eyes of patients receiving ATT less likely to develop a recurrence compared to those not receiving ATT (29.5% vs 48.2%, odds ratio 0.47, 95% confidence interval 0.29-0.77, P = .003). Eyes treated with ATT recurred at an estimated median of 120 months, compared with 51 months in eyes with no treatment (P = .005).

Conclusions: Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antitubercular Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Ethambutol / therapeutic use
  • Female
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Interferon-gamma Release Tests
  • Isoniazid / therapeutic use
  • Latent Tuberculosis / diagnosis
  • Latent Tuberculosis / drug therapy*
  • Latent Tuberculosis / microbiology
  • Male
  • Middle Aged
  • Pyrazinamide / therapeutic use
  • Recurrence
  • Retrospective Studies
  • Rifampin / therapeutic use
  • Treatment Outcome
  • Tuberculosis, Ocular / diagnosis
  • Tuberculosis, Ocular / drug therapy*
  • Tuberculosis, Ocular / microbiology
  • Uveitis / diagnosis
  • Uveitis / drug therapy*
  • Uveitis / microbiology
  • Visual Acuity / physiology

Substances

  • Antitubercular Agents
  • Glucocorticoids
  • Immunosuppressive Agents
  • Pyrazinamide
  • Ethambutol
  • Isoniazid
  • Rifampin