Ma Rui-Qi, Gan Lu, Bi Ying-Wen, Yuan Yi-Fei, Ren Hui, Qian Jiang
Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.
NHC Key Laboratory of Myopia (Fudan University), Shanghai 200031, China.
Int J Ophthalmol. 2018 Nov 18;11(11):1865-1869. doi: 10.18240/ijo.2018.11.20. eCollection 2018.
Experts lack knowledge of periocular tuberculosis (TB) in China. Nested polymerase chain reaction (PCR) shows advantages in diagnosis of extrapulmonary TB. Our study aims to explore the clinical and laboratory features of PCR-confirmed periocular TB. We retrospectively reviewed medical records of presumptive periocular TB and performed nested PCR test to confirm diagnosis. Nine cases were recruited. Clinical symptoms were chronic and insidious. Eight cases achieved favorable visual acuity, while one underwent enucleation due to fungal-TB panophthalmitis. Sensitivity of caseous necrosis, acid-fast bacilli (AFB) staining and interferon γ release assay (T-SPOT) test are 33.3%, 44.4% and 85.7% respectively. Low lymphocyte percentage (=0.019) and high monocyte-lymphocyte ratio (=0.042) positively correlate with AFB staining. Male gender (=0.048) and Langhans giant cell (=0.048) positively correlate with caseous necrosis. To conclude, traditional TB ancillary tests are not as sensitive as nested PCR technique. Several factors facilitate diagnosis including male gender, decreased lymphocytes, and typical Langhans giant cells.
中国专家对眼周结核缺乏了解。巢式聚合酶链反应（PCR）在肺外结核诊断中显示出优势。我们的研究旨在探讨经PCR确诊的眼周结核的临床和实验室特征。我们回顾性分析了疑似眼周结核的病历，并进行巢式PCR检测以确诊。共纳入9例病例。临床症状呈慢性且隐匿。8例视力良好，1例因真菌性结核性全眼球炎而摘除眼球。干酪样坏死、抗酸杆菌（AFB）染色及干扰素γ释放试验（T-SPOT）检测的敏感度分别为33.3%、44.4%和85.7%。低淋巴细胞百分比（=0.019）及高单核细胞-淋巴细胞比值（=0.042）与AFB染色呈正相关。男性（=0.048）及朗汉斯巨细胞（=0.048）与干酪样坏死呈正相关。总之，传统结核辅助检查不如巢式PCR技术敏感。包括男性、淋巴细胞减少及典型朗汉斯巨细胞等多个因素有助于诊断。
