Department of Ophthalmology, Ajou University School of Medicine , Suwon , South Korea.
Department of Ophthalmology, Northwestern University, Feinberg School of Medicine , Chicago , Illinois , USA.
Ocul Immunol Inflamm. 2019;27(6):998-1009. doi: 10.1080/09273948.2018.1485958. Epub 2018 Jul 3.
: To describe tuberculous uveitis (TU) presenting as a bullous retinal detachment (RD) and to perform a comprehensive literature review on TU with similar features. : Observational case report and systematic literature review. : An 84-year-old woman presented with bilateral granulomatous uveitis and bullous RD in the left eye. The interferon gamma release assay was strongly positive, but all other tests were unremarkable. The patient was diagnosed with TU and started on anti-tubercular therapy (ATT) and systemic steroids with excellent treatment response. Twenty-six articles (32 cases) reported TU with exudative RD. Choroidal tuberculoma was the most common clinical manifestation, followed by optic disc edema and retinal exudate. Systemic steroids with ATT improved vision in more patients (78.6%) than ATT alone (50.0%) or oral steroids followed by ATT (50.0%). : Atypical presentations of TU make diagnosis and treatment difficult. A high level of suspicion for TU is needed to minimize ocular morbidity.
: 描述以大疱性视网膜脱离（RD）为表现的结核性葡萄膜炎（TU），并对具有类似特征的 TU 进行全面的文献复习。 : 观察性病例报告和系统文献复习。 : 一位 84 岁女性因双眼肉芽肿性葡萄膜炎和左眼大疱性 RD 就诊。干扰素γ释放试验呈强阳性，但其他所有检查均无明显异常。患者被诊断为 TU，并开始接受抗结核治疗（ATT）和全身皮质类固醇治疗，治疗反应良好。有 26 篇文章（32 例）报道了 TU 合并渗出性 RD。脉络膜结核瘤是最常见的临床表现，其次是视盘水肿和视网膜渗出。与 ATT 单独治疗（50.0%）或口服皮质类固醇后再行 ATT 治疗（50.0%）相比，全身皮质类固醇联合 ATT 治疗能使更多患者（78.6%）的视力得到改善。 : TU 的不典型表现使诊断和治疗变得困难。需要高度怀疑 TU，以最大限度地减少眼部发病率。
