Original article
Role of Anti-Tubercular Therapy in Uveitis With Latent/Manifest Tuberculosis

https://doi.org/10.1016/j.ajo.2008.06.011Get rights and content

Purpose

To assess the role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis (TB).

Design

Retrospective, interventional case series.

Methods

A total of 360 patients from uveitis clinic with following inclusion criteria were studied: 1) complete clinical records of visual acuity, slit-lamp biomicroscopic examination, intraocular pressure, complications if any, and treatment records at the baseline and at all follow-up visits; 2) a documented positive tuberculin skin test (10 mm of induration or more) at 48 to 72 hours; 3) evidence of active uveitis, i.e., cellular reaction in the anterior chamber with or without keratic precipitates, and/or active vitreous inflammation, retinal vasculitis, choroiditis, or neuroretinitis; 4) all known causes of infectious uveitis except TB and known noninfectious uveitic syndromes ruled out; and 5) a minimum one year of follow-up from the initiation of treatment. Of these, 216 patients (Group A) received four-drug anti-tubercular therapy and corticosteroids, and 144 patients (Group B) received corticosteroids alone. The main outcome measure was recurrence of inflammation after minimum six months of initiating treatment in each group.

Results

Recurrences reduced significantly (P < .001) in Group A (15.74%) as compared to Group B (46.53%) over a median follow-up of 24 and 31 months, respectively. The patients treated with anti-tubercular therapy with corticosteroids had decreased risk of developing recurrence of uveitis by approximately two-thirds as compared to those treated with corticosteroids alone.

Conclusion

Addition of anti-tubercular therapy to corticosteroids in uveitis patients with latent/manifest TB led to significant reduction in recurrences of uveitis.

Section snippets

Methods

Of the 4,000 patients who presented to the uveitis clinic at the Post Graduate Institute of Medical Education and Research, Chandigarh, India, between January 11, 1991 and September 5, 2005, patients who met the inclusion criteria were included in this study and assigned to Group A (216 patients) if they received anti-tubercular therapy along with standard corticosteroid therapy (topical, periocular, and/or oral), and Group B (144 patients) if they received standard corticosteroid therapy

Results

Of 350 patients with uveitis who were started on anti-tubercular therapy for latent/manifest TB, 134 patients (38.3%) did not complete the treatment course. The reasons for not completing the treatment were: 1) failure to follow-up (92 patients); 2) intolerance or adverse side effects to anti-tubercular therapy (14 patients); and 3) poor compliance (28 patients). Thus, there were 216 patients in Group A, 104 men and 112 women, with a mean age of 34.68 ± 12.18 years (age range, 12 to 70 years).

Discussion

Etiology cannot be established in 30% to 60% of uveitis patients.33 In TB-endemic areas such as India, the association of latent TB with uveitis is often ignored. Such patients continue to carry a label of idiopathic uveitis and are treated with local (topical, periocular) and/or systemic corticosteroids depending upon the location of uveitis.

The true prevalence of tubercular uveitis remains a major concern in TB-endemic areas. Demonstration of acid-fast bacilli on smear or histopathology of

Reema Bansal is a Senior Research Associate in the Department of Ophthalmology at the Advanced Eye Centre at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She is currently working on diseases of Retina and Uvea.

References (41)

  • S.K. Kurup et al.

    Gamma interferon assay as an alternative to PPD skin testing in selected patients with granulomatous intraocular inflammatory disease

    Can J Ophthalmol

    (2006)
  • R. Singh et al.

    Pattern of uveitis in a referral eye clinic in North India

    Indian J Ophthalmol

    (2004)
  • T. Wakabayashi et al.

    Changing patterns of intraocular inflammatory disease in Japan

    Ocul Immunol Inflamm

    (2003)
  • S.M. Islam et al.

    Causes of uveitis at the eye center in Saudi Arabia: a retrospective review

    Ophthalmic Epidemiol

    (2002)
  • N.A. Rao et al.

    Anterior uveitisIn

  • J. Biswas et al.

    Intraocular tuberculosis: Clinicopathologic study of five cases

    Retina

    (1995)
  • S. Sen et al.

    Intraocular tuberculosis mimicking retinoblastoma

    Diagn Cytopathol

    (2003)
  • N.A. Rao et al.

    Tuberculous uveitis: Distribution of Mycobacterium tuberculosis in the retinal pigment epithelium

    Arch Ophthalmol

    (2006)
  • P.H. Rosen et al.

    Intraocular tuberculosis

    Eye

    (1990)
  • K. Psilas et al.

    Antituberculosis therapy in the treatment of peripheral uveitis

    Ann Ophthalmol

    (1991)
  • Cited by (0)

    Reema Bansal is a Senior Research Associate in the Department of Ophthalmology at the Advanced Eye Centre at the Post Graduate Institute of Medical Education and Research, Chandigarh, India. She is currently working on diseases of Retina and Uvea.

    Amod Gupta is a Professor and heads the Department of Ophthalmology at the Advanced Eye Centre at the Post Graduate Institute of Medical Education and Research, Chandigarh India. He has extensively published original work in diseases of Retina and Uvea.

    View full text