Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung 404, Taiwan.
Medicina (Kaunas). 2022 Mar 3;58(3):376. doi: 10.3390/medicina58030376.
: This 10-year multicenter retrospective study reviewed the clinical manifestations, diagnostic tests, and treatment modalities of tubercular uveitis (TBU), including direct infection and indirect immune-mediated hypersensitivity to mycobacterial antigens in Taiwan. : This retrospective chart review of patients with TBU was conducted at 11 centers from 1 January 2008 to 31 December 2017. We used a multiple regression model to analyze which factors influenced best-corrected visual acuity (BCVA) improvement. : A total of 79 eyes from 51 patients were included in the study. The mean age was 48.9 ± 16.4 years. The mean change of LogMAR BCVA at last visit was -0.21 ± 0.45. Diagnostic tools used include chest X-ray, chest computed tomography, Mantoux test, interferon gamma release test (QuantiFERON-TB Gold test), intraocular fluid tuberculosis polymerase chain reaction, and bronchial alveolar lavage. The clinical manifestations included 48% posterior uveitis and 37% panuveitis. In the sample, 55% of the cases were bilateral and 45% unilateral. There was 60.76% retinal vasculitis, 35.44% choroiditis, 21.52% serpiginous-like choroiditis, 17.72% vitreous hemorrhage, 12.66% posterior synechiae, 6.33% retinal detachment, and 3.80% choroidal granuloma. Treatment modalities included rifampicin, isoniazid, pyrazinamide, ethambutol, oral steroid, posterior triamcinolone, non-steroidal anti-inflammatory drugs, vitrectomy, and immunosuppressants. BCVA improved in 53.2% of eyes and remained stable in 32.9% of eyes. In the final model of multiple regression, worse initial BCVA, pyrazinamide, and receiving vitrectomy predicted better BCVA improvement. Ethambutol was associated with worse visual outcomes. Seven eyes experienced recurrence. : This is the largest 10-year multicenter retrospective study of TBU in Taiwan to date, demonstrating the distribution of clinical manifestations and clinical associations with better treatment outcomes. The study provides a comprehensive description of TBU phenotypes in Taiwan and highlights considerations for the design of further prospective studies to reliably assess the role of ATT and vitrectomy in patients with TBU.
这是台湾地区迄今为止最大的一项为期 10 年的结核性葡萄膜炎（TBU）多中心回顾性研究，分析了 TBU 的临床表现、诊断检测和治疗方法，包括结核分枝杆菌抗原的直接感染和间接免疫介导的过敏反应。
该研究对 2008 年 1 月 1 日至 2017 年 12 月 31 日期间在 11 个中心就诊的 TBU 患者进行了回顾性图表分析。我们使用多元回归模型分析了哪些因素影响最佳矫正视力（BCVA）的改善。
本研究共纳入 51 例患者的 79 只眼。患者的平均年龄为 48.9±16.4 岁。末次随访时 LogMAR BCVA 的平均变化为-0.21±0.45。使用的诊断工具包括胸部 X 线、胸部计算机断层扫描、曼托试验、干扰素-γ释放试验（QuantiFERON-TB Gold 试验）、眼内液结核分枝杆菌聚合酶链反应和支气管肺泡灌洗。临床表现包括 48%的后葡萄膜炎和 37%的全葡萄膜炎。在样本中，55%的病例为双侧，45%为单侧。视网膜血管炎 60.76%，脉络膜炎 35.44%，匐行性脉络膜炎 21.52%，玻璃体积血 17.72%，后粘连 12.66%，视网膜脱离 6.33%，脉络膜肉芽肿 3.80%。治疗方法包括利福平、异烟肼、吡嗪酰胺、乙胺丁醇、口服类固醇、后三联曲安奈德、非甾体抗炎药、玻璃体切除术和免疫抑制剂。53.2%的眼视力改善，32.9%的眼视力稳定。多元回归的最终模型显示，初始 BCVA 较差、使用吡嗪酰胺和接受玻璃体切除术预示着更好的 BCVA 改善。乙胺丁醇与较差的视力结果相关。7 只眼出现复发。
这是迄今为止台湾地区最大的一项为期 10 年的结核性葡萄膜炎（TBU）多中心回顾性研究，展示了 TBU 的临床表现分布和与更好治疗结果的临床关联。该研究全面描述了台湾地区 TBU 的表型，并强调了进一步前瞻性研究设计的考虑因素，以可靠地评估 ATT 和玻璃体切除术在 TBU 患者中的作用。
