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Journal of Ophthalmic Inflammation and Infection

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Open Access 01-12-2017 | Original research

A retrospective cohort study of patients treated with anti-tuberculous therapy for presumed ocular tuberculosis

Authors: Erika Marie Damato, Sarah Dawson, Xiaoxuan Liu, Chandoshi Mukherjee, John Horsburgh, Alastair K. Denniston, Edward Moran, Martin Dedicoat, Philip Ian Murray

Published in: Journal of Ophthalmic Inflammation and Infection | Issue 1/2017

Abstract

Background

Uveitis involving the posterior segment is a significant and potentially blinding condition. The diagnosis and treatment of patients with uveitis associated with tuberculosis remains controversial, and commonly, patients are systemically well. Use of the interferon-gamma release assays has added to the controversy, as the significance of a positive test may be uncertain. We aim to report the outcomes of anti-tuberculous treatment in a cohort of patients treated in Birmingham, for presumed “ocular tuberculosis”, based on clinical findings, systemic assessment and specific testing for tuberculosis.

Results

We found that in our cohort of 41 patients treated between 2010 and 2014, the majority achieved disease-free remission, even in cases where anti-tuberculous treatment was delayed.

Conclusions

Despite controversy, this study strongly supports the use of anti-tuberculous therapy in such patients and highlights the need for formal prospective trials and treatment protocols.

SUN WORKING GROUP (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 140(3):509–516. doi:10.1016/j.ajo.2005.03.057 CrossRef

Deschenes J, Murray PI, Rao NA, Nussenblatt RB (2008) International Uveitis Study Group International Uveitis Study Groupd (IUSG): clinical classification of uveitis. Ocul Immunol Inflamm 16(1):1–2.

Durrani OM, Tehrani NN, Marr JE, Moradi P, Stavrou P, Murray PI (2004) Degree, duration, and causes of visual loss in uveitis. Br J Ophthalmol 88:1159–1162. doi:10.1136/bjo.2003.037226 CrossRefPubMedPubMedCentral

de Smet MD, Taylor SRJ, Bodaghi B et al (2011) Understanding uveitis: the impact of research on visual outcomes. Prog Retin Eye Res 30(6):452–470. doi:10.1016/j.preteyeres.2011.06.005 CrossRefPubMed

Davidson M (1929) The modern approach to the problem of ocular tuberculosis: Werdenberg, E. Schweiz. Am J Ophthalmol 59(6):126

Al-Baker ZM, Bodaghi B, Khan SA (2016) Clinical patterns and causes of uveitis in a referral eye clinic in Qatar. Ocul Immunol Inflamm 0(0):1–10. doi:10.1080/09273948.2016.1206573

Sabhapandit S, Murthy SI, Singh VM et al (2016) Epidemiology and clinical features of uveitis from urban populations in South India. Ocul Immunol Inflamm 0(0):1–7. doi:10.1080/09273948.2016.1236971

Dogra M, Singh R, Agarwal A et al (2016) Epidemiology of uveitis in a tertiary-care referral institute in North India. Ocul Immunol Inflamm 0(0):1–8. doi:10.1080/09273948.2016.1255761

Nguyen M, Siak J, Chee S-P, Diem VQH (2016) The spectrum of uveitis in Southern Vietnam. Ocul Immunol Inflamm 0(0):1–7. doi:10.1080/09273948.2016.1231826

10.

Wong A, McKelvie J, Slight C, Sims J (2017) Land of the Long White Cloud: The Spectrum of Uveitis at a Tertiary Referral Center in New Zealand. Ocul Immunol Inflamm 25(sup1):S115–S121.

11.

Jones NP (2015) The Manchester Uveitis Clinic: the first 3000 patients—epidemiology and casemix. Ocul Immunol Inflamm 23(2):118–126. doi:10.3109/09273948.2013.855799 CrossRefPubMed

12.

Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN (2014) Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology 121(3):785–796. doi:10.1016/j.ophtha.2013.09.048 CrossRefPubMed

13.

Jabs DA, Rosenbaum JT, Foster CS et al (2000) Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 130(4):492–513 Available at: http://www.ncbi.nlm.nih.gov/pubmed/11024423 CrossRefPubMed

14.

Tomkins-Netzer O, Talat L, Bar A et al (2014) Long-term clinical outcome and causes of vision loss in patients with uveitis. Ophthalmology 121(12):2387–2392. doi:10.1016/j.ophtha.2014.07.007 CrossRefPubMed

15.

Varma D, Anand S, Reddy AR et al., Tuberculosis: an under-diagnosed aetiological agent in uveitis with an effective treatment. Eye (Lond) 20(9):1068–1073 doi:10.1038/sj.eye.6702):1068-73. doi:10.1038/sj.eye.6702093

16.

Singh R, Toor P, Parchand S, Sharma K, Gupta V, Gupta A (2012) Quantitative polymerase chain reaction for mycobacterium tuberculosis in so-called Eales’ disease. Ocul Immunol Inflamm 20(3):153–157. doi:10.3109/09273948.2012.658134 CrossRefPubMed

17.

Singh U, Mohapatra S, Wagh V, Porwal C, Kaushik A, Rajpal (2015) Association of mycobacterium tuberculosis in the causation of Eales’ disease: an institutional experience. Indian J Med Microbiol 33(5):43. doi:10.4103/0255-0857.148829

18.

Bansal R, Sharma K, Gupta A et al (2015) Detection of mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis. Ophthalmology 122(4):840–850. doi:10.1016/j.ophtha.2014.11.021 CrossRefPubMed

19.

Biswas J, Kazi M, Agarwal V, Alam MS, Kl T (2016) Polymerase chain reaction for mycobacterium tuberculosis DNA detection from ocular fluids in patients with various types of choroiditis in a referral eye center in India. Indian J Ophthalmol 64(12):904. doi:10.4103/0301-4738.198857 CrossRefPubMedPubMedCentral

20.

Bhagya S, Lalitha P, Kumar AL, Rathinam S (2017) Polymerase chain reaction and its correlation with clinical features and treatment response in tubercular uveitis. Ocul Immunol Inflamm 0(0):1–8. doi:10.1080/09273948.2017.1287925

21.

Ang M, Wong W, Ngan CCL, Chee S-P (2012) Interferon-gamma release assay as a diagnostic test for tuberculosis-associated uveitis. Eye (Lond) 26(5):658–665. doi:10.1038/eye.2012.1 CrossRef

22.

Cordero-Coma M, Calleja S, Torres HE et al (2010) The value of an immune response to mycobacterium tuberculosis in patients with chronic posterior uveitis revisited: utility of the new IGRAs. Eye (Lond) 24(1):36–43. doi:10.1038/eye.2009.51 CrossRef

23.

Ang M, Chee S-P (2017) Controversies in ocular tuberculosis. Br J Ophthalmol 101(1):6–9. doi:10.1136/bjophthalmol-2016-309531 CrossRefPubMed

24.

Bramante CT, Talbot E a, Rathinam SR, Stevens R, Zegans ME (2007) Diagnosis of ocular tuberculosis: a role for new testing modalities? Int Ophthalmol Clin 47(3):45–62. doi:10.1097/IIO.0b013e318074de79

25.

Ang M, Vasconcelos-Santos DV, Sharma K et al (2016) Diagnosis of ocular tuberculosis. Ocul Immunol Inflamm 3948(July):1–9. doi:10.1080/09273948.2016.1178304 CrossRef

26.

Ang M, Htoon HM, Chee SP (2009) Diagnosis of tuberculous uveitis: clinical application of an interferon-gamma. OPHTHA 116(7):1391–1396. doi:10.1016/j.ophtha.2009.02.005 CrossRef

27.

Bansal R, Gupta A, Gupta V, Dogra MR, Bambery P, Arora SK (2008) Role of anti-tubercular therapy in uveitis with latent/manifest tuberculosis. Am J Ophthalmol 146(5). doi:10.1016/j.ajo.2008.06.011

28.

Agrawal R, Gupta B, Gonzalez-lopez FJJ, et al. The role of anti-tubercular therapy in patients with presumed ocular tuberculosis. 2015;23(October 2014):40-46. doi:10.3109/09273948.2014.986584

29.

Ang M, Hedayatfar A, Wong W, Chee S-P (2012) Duration of anti-tubercular therapy in uveitis associated with latent tuberculosis: a case–control study. Br J Ophthalmol 96(3):332–336. doi:10.1136/bjophthalmol-2011-300209 CrossRefPubMed

30.

Kee AR, Gonzalez-lopez JJ, Al-hity A et al (2016) Anti-tubercular therapy for intraocular tuberculosis: a systematic review and meta- analysis. Surv Ophthalmol 61(5):628–653. doi:10.1016/j.survophthal.2016.03.001.This

31.

Lou SM, Larkin KL, Winthrop K, Rosenbaum JT (2015) Lack of consensus in the diagnosis and treatment for ocular tuberculosis among uveitis specialists. Ocul Immunol Inflamm 23(1):25–31. doi:10.3109/09273948.2014.926936

32.

Conant MM, Vrasich CR, Wongskhaluang J V, et al. Role of the infectious disease consultant in management of patients with tuberculosis-associated ocular inflammation. 2015:1-5. doi:10.1093/ofid/ofv195

33.

Keane J, Gershon S, Wise R, et al. Tuberculosis associated with Infliximab,. 2001;345(15):1098-1104.

34.

Agrawal R, Gonzalez-Lopez J, Nobre-Cardoso J et al (2013) Predictive factors for treatment failure in patients with presumed ocular tuberculosis in an area of low endemic prevalence. Br J Ophthalmol 17(11):545149. doi:10.1136/bjophthalmol-2014-306474

35.

Gunasekeran DV, Gupta B, Cardoso J, Pavesio CE, Agrawal R (2017) Visual morbidity and ocular complications in presumed intraocular tuberculosis: an analysis of 354 cases from a non-endemic population. Ocul Immunol Inflamm 0(0):1–5. doi:10.1080/09273948.2017.1296580

Title: A retrospective cohort study of patients treated with anti-tuberculous therapy for presumed ocular tuberculosis
Authors: Erika Marie Damato
Sarah Dawson
Xiaoxuan Liu
Chandoshi Mukherjee
John Horsburgh
Alastair K. Denniston
Edward Moran
Martin Dedicoat
Philip Ian Murray
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Journal of Ophthalmic Inflammation and Infection / Issue 1/2017
Electronic ISSN: 1869-5760
DOI: https://doi.org/10.1186/s12348-017-0141-4

At a glance: The STEP trials

Springer Medicine

A retrospective cohort study of patients treated with anti-tuberculous therapy for presumed ocular tuberculosis

Abstract

Background

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Results

Conclusions

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