Retina and Uveitis Service, L V Prasad Eye Institute (Mithu Tulsi Chanrai Campus), Bhubaneswar, India.
NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK.
Tuberculosis (Edinb). 2020 Sep;124:101961. doi: 10.1016/j.tube.2020.101961. Epub 2020 Jul 24.
Ocular tuberculosis (OTB) encompasses all forms of intra- and extra-ocular inflammation associated with Mycobacterium tuberculosis (Mtb) infection. However, the organism is rarely found in ocular fluid samples of diseased eyes, rendering the pathomechanisms of the disease unclear. This confounds clinical decision-making in diagnosis and treatment of OTB. Here, we critically review existing human and animal data related to ocular inflammation and TB pathogenesis to unravel likely pathomechanisms of OTB. Broadly there appear to be two fundamental mechanisms that may underlie the development of TB-associated ocular inflammation: a. inflammatory response to live/replicating Mtb in the eye, and b. immune mediated ocular inflammation induced by non-viable Mtb or its components in the eye. This distinction is significant as in direct Mtb-driven mechanisms, diagnosis and treatment would be aimed at detection of Mtb-infection and its elimination; while indirect mechanisms would primarily require anti-inflammatory therapy with adjunctive anti-TB therapy. Further, we discuss how that most clinical phenotypes of OTB likely represent a combination of both mechanisms, with one being predominant than the other.
眼结核（OTB）包括与结核分枝杆菌（Mtb）感染相关的所有形式的眼内和眼外炎症。然而，该生物体很少在患病眼睛的眼液样本中发现，这使得疾病的发病机制不清楚。这使得 OTB 的诊断和治疗中的临床决策变得复杂。在这里，我们批判性地回顾了与眼部炎症和结核病发病机制相关的现有人类和动物数据，以揭示 OTB 可能的发病机制。从广义上讲，似乎有两种基本机制可能是导致与结核病相关的眼部炎症的原因：a. 眼部活/复制 Mtb 引起的炎症反应，和 b. 眼部非存活 Mtb 或其成分引起的免疫介导的眼部炎症。这种区别很重要，因为在直接的 Mtb 驱动机制中，诊断和治疗的目的是检测 Mtb 感染并消除它；而间接机制主要需要抗炎治疗，辅以抗结核治疗。此外，我们还讨论了 OTB 的大多数临床表型可能代表这两种机制的组合，其中一种机制比另一种更为主要。
