Arora S K, Gupta V, Gupta A, Bambery P, Kapoor G S, Sehgal S
Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Tuber Lung Dis. 1999;79(4):229-33. doi: 10.1054/tuld.1999.0210.
The granulomatous uveitis, multifocal choroiditis and periphlebitis have been suspected to be of tubercular origin but no definitive reports about detection of etiological agents have been documented in the literature. Conventional bacteriological methods are not generally helpful in diagnosing ocular tuberculosis due to difficulty with potential morbidity associated with obtaining the biopsy material from the eye. Thus, the diagnosis of ocular tuberculosis is most often presumptive.
We evaluated the role of polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis in the aqueous humor samples obtained from eyes with active uveitis.
Aqueous samples from 53 patients having cellular reaction in the anterior chamber along with any one or more of the following: 1) active vasculitis; 2) anterior vitreous cells; 3) snowball opacities; 4) snow banking in the pars plana; 5) retinochoroiditis were withdrawn by anterior chamber paracentesis and subjected to PCR. Seventeen samples from patients with definite clinical diagnoses other than tuberculosis formed a disease control group. Fifteen aqueous samples obtained from healthy subjects undergoing routine cataract surgery served as healthy controls. PCR was performed using primers capable of amplifying a 150 b.p. segment from a conserved repetitive sequence in the genome of M. tuberculosis.
Twenty out of the 53 samples (37.7%) in the study group were positive where as only one sample out of 17 in the disease control group (5.7%) showed a weakly positive band. No sample from the healthy control group showed a positive PCR.
Our study shows that PCR can be effectively used for the diagnosis of intraocular tuberculosis in the presence of uveitis.
肉芽肿性葡萄膜炎、多灶性脉络膜炎和周边静脉炎一直被怀疑起源于结核，但文献中尚无关于病原体检测的确切报道。由于从眼部获取活检材料存在潜在的发病风险，传统的细菌学方法通常无助于诊断眼部结核。因此，眼部结核的诊断往往是推测性的。
我们评估了聚合酶链反应（PCR）在检测活动性葡萄膜炎患者房水样本中结核分枝杆菌的作用。
对53例前房有细胞反应且伴有以下任何一种或多种情况的患者采集房水样本：1）活动性血管炎；2）前玻璃体细胞；3）雪球样混浊；4）睫状体扁平部雪堤样病变；5）视网膜脉络膜炎，通过前房穿刺获取样本并进行PCR检测。17例明确临床诊断非结核患者的样本作为疾病对照组。15例接受常规白内障手术的健康受试者的房水样本作为健康对照组。使用能够扩增结核分枝杆菌基因组中保守重复序列的150个碱基对片段的引物进行PCR检测。
研究组53例样本中有20例（37.7%）呈阳性，而疾病对照组17例样本中只有1例（5.7%）显示弱阳性条带。健康对照组样本均未显示PCR阳性。
我们的研究表明，在葡萄膜炎存在的情况下，PCR可有效用于眼内结核的诊断。
