Figueira L, Fonseca S, Ladeira I, Duarte R
Portuguese Society of Ophthalmology, Lisboa, Portugal.
Portuguese Society of Pulmonology, Lisboa, Portugal.
Rev Port Pneumol (2006). 2017 Jan-Feb;23(1):31-38. doi: 10.1016/j.rppnen.2016.10.004. Epub 2016 Dec 14.
Delay in diagnosis or treatment of ocular tuberculosis can result in loss of vision. However, due to the fact that early diagnosis is rarely achieved, there are still a broad variety of diagnostic and treatment approaches. Our aim was to reach a consensus on the management of diagnosis and treatment of ocular tuberculosis.
Critical appraisal of the literature and expert opinion on diagnosis and treatment of ocular tuberculosis.
The currently recommended method for ocular TB diagnosis is screening for tuberculosis in any uveitis of unknown etiology, recurrent or not responding to conventional therapy; in ocular findings highly suggestive of ocular TB and before immunosuppression (particularly biologic agents). TB screening in these cases includes tuberculosis skin testing and interferon gamma testing, along with complete medical history, ophthalmologic evaluation and chest imaging. Positively screened patients should be treated for active tuberculosis with 4 drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) for 6-9 months. Patients should be reviewed at the end of the initiation phase (two months) and at the end of the overall treatment (6-9 months).
眼部结核病诊断或治疗的延迟可能导致视力丧失。然而，由于早期诊断很少能实现，目前仍有各种各样的诊断和治疗方法。我们的目的是就眼部结核病的诊断和治疗管理达成共识。
对眼部结核病诊断和治疗的文献进行批判性评估并征求专家意见。
目前推荐的眼部结核病诊断方法是，在任何病因不明的葡萄膜炎（无论是否复发或对传统治疗无反应）、高度提示眼部结核病的眼部表现以及免疫抑制（特别是生物制剂）之前，对结核病进行筛查。这些病例中的结核病筛查包括结核菌素皮肤试验和干扰素γ检测，以及完整的病史、眼科评估和胸部影像学检查。筛查呈阳性的患者应使用4种药物（异烟肼、利福平、吡嗪酰胺和乙胺丁醇）治疗活动性结核病6至9个月。应在起始阶段结束时（两个月）和整个治疗结束时（6至9个月）对患者进行复查。
