Demirci Hakan, Shields Carol L, Shields Jerry A, Eagle Ralph C
Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Surv Ophthalmol. 2004 Jan-Feb;49(1):78-89. doi: 10.1016/j.survophthal.2003.10.009.
Tuberculosis has re-emerged as a serious public health problem in recent years. The ocular manifestations of tuberculosis are uncommon and diverse. Occasionally, patients initially present with ocular symptoms that simulate intraocular malignancy or other inflammatory conditions. We present five patients with ocular tuberculosis who were referred with the suspicion of ocular malignancy. Four of the five patients had recently emigrated to the United States. The presenting features of these patients were panophthalmitis (one patient), endophthalmitis leading to scleral perforation (one patient), active choroidal granuloma associated with uveitis (two patients), and amelanotic choroidal lesion without inflammatory signs (one patient). Of these five cases, two had a known history of systemic tuberculosis, while the ocular findings in the other three cases were the presenting manifestation of systemic tuberculosis. Multi-drug antituberculous regimen were employed in all cases for a mean of 9 months (median 6 months, range 6-12 months). Three patients responded well to therapy with salvage of the globe and the two remaining patients underwent primary enucleation for blind painful eye or perforated eye. In conclusion, ocular tuberculosis can have variable clinical manifestations and occasionally appears as an intraocular or epibulbar tumor. A high degree of clinical suspicion is important, especially in immigrants from developing countries.
近年来，结核病再度成为一个严重的公共卫生问题。结核病的眼部表现并不常见且多种多样。偶尔，患者最初会出现类似眼内恶性肿瘤或其他炎症性疾病的眼部症状。我们报告了5例疑似眼内恶性肿瘤而转诊的眼部结核患者。这5例患者中有4例最近移民到了美国。这些患者的临床表现为全眼球炎（1例）、导致巩膜穿孔的眼内炎（1例）、与葡萄膜炎相关的活动性脉络膜肉芽肿（2例）以及无炎症体征的无色素性脉络膜病变（1例）。在这5例病例中，2例有已知的系统性结核病史，而其他3例的眼部表现为系统性结核的首发症状。所有病例均采用多药抗结核方案治疗，平均治疗9个月（中位数6个月，范围6 - 12个月）。3例患者对治疗反应良好，眼球得以保留，另外2例患者因患眼失明疼痛或眼球穿孔而接受了一期眼球摘除术。总之，眼部结核可具有多种临床表现，偶尔表现为眼内或眼球表面肿瘤。高度的临床怀疑很重要，特别是对于来自发展中国家的移民。
