L V Prasad Eye Institute, Bhubaneswar, India.
Eye (Lond). 2013 May;27(5):657-62. doi: 10.1038/eye.2013.5. Epub 2013 Mar 1.
To analyze the incidence and clinical course of patients developing progressive ocular inflammation following anti-tubercular therapy (ATT) for presumed ocular tuberculosis (TB).
Retrospective analysis of medical records of patients who received ATT for presumed ocular TB and completed at least 12 months follow-up after initiation of ATT. The diagnosis of presumed ocular TB was based on presence of ocular signs suggestive of TB, evidence of past tubercular infection, and exclusion of mimicking clinical entities. All patients received a combination of ATT and corticosteroid therapy. Primary outcome measure was progression (worsening) of ocular inflammation, defined as a two-step increase in level of inflammation (anterior chamber/ vitreous) or the appearance of new lesions following initiation of ATT.
A total of 106 patients (64 male, 42 female) received ATT for presumed ocular TB. Twenty-six (24.5%) patients developed progressive intraocular inflammation following ATT. Primary diagnoses in these patients were: anterior uveitis (n=1), intermediate uveitis (n=9), retinal vasculitis (n=3), serpiginous-like choroiditis (n=7), multifocal choroiditis (n=2), and pan-uveitis (n=4). Following progressive inflammation, diagnosis was revised in two patients (7.7%)-both responded to alternative therapy. Of the rest, majority (n=16; 61.5%) resolved with escalation of corticosteroid therapy. Five patients (19.2%)-all having intermediate uveitis-required therapeutic vitrectomy for resolution. Three patients (11.5%) had persistent inflammation at end of follow-up period.
Progressive inflammation following ATT for presumed ocular TB is common. It generally resolves on escalation of corticosteroid therapy. Cases not responding to increased immunosuppression need to be re-investigated to rule out a nontubercular cause.
分析疑似眼结核（TB）患者接受抗结核治疗（ATT）后出现进行性眼内炎症的发生率和临床病程。
对接受疑似眼 TB 接受 ATT 治疗并在开始 ATT 后至少完成 12 个月随访的患者的病历进行回顾性分析。疑似眼 TB 的诊断基于眼部存在提示 TB 的体征、过去结核感染的证据以及排除类似临床实体。所有患者均接受 ATT 和皮质类固醇联合治疗。主要观察指标是炎症（前房/玻璃体）的两个步骤增加或 ATT 开始后出现新病变，定义为眼部炎症进展（加重）。
共有 106 名（64 名男性，42 名女性）患者因疑似眼 TB 接受 ATT 治疗。26 名（24.5%）患者在 ATT 后出现进行性眼内炎症。这些患者的主要诊断为：前葡萄膜炎（n=1）、中间葡萄膜炎（n=9）、视网膜血管炎（n=3）、匐行性脉络膜炎（n=7）、多灶性脉络膜炎（n=2）和全葡萄膜炎（n=4）。进行性炎症后，两名患者（7.7%）的诊断被修订-两者均对替代疗法有反应。其余患者中，多数（n=16；61.5%）通过增加皮质类固醇治疗得到缓解。五名患者（19.2%）-均为中间葡萄膜炎-需要治疗性玻璃体切除术才能缓解。三名患者（11.5%）在随访结束时仍有炎症。
疑似眼 TB 接受 ATT 后出现进行性炎症很常见。一般通过增加免疫抑制治疗即可缓解。对不响应增加免疫抑制治疗的病例需要重新检查以排除非结核病因。
