Elsevier

Ophthalmology

Volume 122, Issue 4, April 2015, Pages 840-850
Ophthalmology

Original article
Detection of Mycobacterium tuberculosis Genome in Vitreous Fluid of Eyes with Multifocal Serpiginoid Choroiditis

Presented as a poster at: American Academy of Ophthalmology Annual Meeting, October 2014, Chicago, Illinois.
https://doi.org/10.1016/j.ophtha.2014.11.021Get rights and content

Purpose

To compare 3 different molecular techniques to detect the Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis (MSC).

Design

Prospective, interventional case series.

Participants

Eleven patients (11 eyes) with active MSC in at least 1 eye underwent diagnostic pars plana vitrectomy (PPV) between October 2012 and December 2013.

Methods

Vitreous fluid samples were subjected to multitargeted polymerase chain reaction (PCR) for a M. tuberculosis assay, the Gene Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and a line probe assay (GenoType MTBDRplus; Hain Lifescience, GmbH, Nehren, Germany). The samples with positive results were subjected to rpoB gene sequencing to demonstrate rifampicin resistance. The clinical details, digital fundus imaging, and treatment details and outcomes also were noted.

Main Outcome Measures

Detection of the M. tuberculosis genome and rifampicin resistance in the vitreous samples.

Results

Of the 11 eyes subjected to PPV, the multitargeted PCR results for tuberculosis were positive for 10 eyes, the MTBDRplus assay results were positive in 6 eyes, and the Gene Xpert MTB/RIF assay results were positive in 4 eyes. Rifampicin resistance was detected in 3 eyes by rpoB gene sequencing, in 3 eyes by the MTBDRplus assay, and in 1 eye by the Gene Xpert MTB/RIF assay.

Conclusions

We detected the M. tuberculosis genome in the vitreous fluid of eyes with MSC using 3 different molecular techniques. Rifampicin resistance was detected for the first time in eyes with MSC.

Section snippets

Methods

We prospectively enrolled 11 patients (11 eyes) with active MSC in 1 or both eyes between October 2012 and December 2013 using following inclusion criteria: (1) evidence of active MSC lesions with central healing and active edges that showed early hypofluorescence and late hyperfluorescence on fluorescein angiography in at least 1 eye; (2) presence of significant vitreous cells (2+ or more) in the affected eye with or without anterior segment inflammation; (3) documented positive (10 mm of

Results

During the study period, 13 patients who met the inclusion criteria were offered the option of PPV. Of these, 2 patients declined. There were 8 males and 3 females. The mean age was 28.1±10.18 years (range, 15–50 years). The disease was bilateral in 5 patients. Nine patients had positive TST or QuantiFERON-TB Gold In-Tube test results. The multitargeted PCR results were positive in 10 eyes (Fig 2). Of the 10 eyes with positive PCR results, rpoB gene sequencing for rifampicin resistance detected

Discussion

This is the first study of diagnostic PPV demonstrating the presence of M. tuberculosis DNA in the vitreous fluid of eyes with MSC. In this series, different molecular techniques established a definitive diagnosis of tuberculosis, such as multitargeted PCR analysis in 10 of 11 patients (previously reported sensitivity of 77.8%),10 the MTBDRplus assay in 6 cases, and the Gene Xpert MTB/RIF assay in 4 cases.

Multifocal serpiginous choroiditis presents as an isolated ocular disease, and definitive

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the Department of Biotechnology, Ministry of Science and Technology, Government of India, New Delhi, India.

    Both Dr. Bansal and Dr. Sharma contributed equally as first authors.

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