Tungsattayathitthan Usanee, Boonsopon Sutasinee, Tesavibul Nattaporn, Dharakul Tararaj, Choopong Pitipol
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Int J Ophthalmol. 2022 Sep 18;15(9):1520-1528. doi: 10.18240/ijo.2022.09.16. eCollection 2022.
Tuberculous uveitis (TBU) comprises a broad clinical spectrum of ocular manifestations, making its diagnosis challenging. Ophthalmologists usually require evidence from investigations to confirm or support a clinical diagnosis of TBU. Since direct isolation of the causative organism from ocular specimens has limitations owing to the small volume of the ocular specimens, resultant test positivities are low in yield. Immunodiagnostic tests, including the tuberculin skin test and interferon-gamma release assays (IGRAs), can help support a clinical diagnosis of TBU. Unlike the tuberculin skin test, IGRAs are tests that require a single visit and are not affected by prior Bacillus Calmette-Guerin vaccination. Currently, available IGRAs consist of different techniques and interpretation methods. Moreover, newer generations have been developed to improve the sensitivity and ability to detect active tuberculosis. This narrative review collates salient practice points as a reference for general ophthalmologists, such as evidence for the utilization of IGRAs in patients with suspected TBU, and summarizes basic knowledge and details of clinical applications of these tests in a clinical setting.
结核性葡萄膜炎（TBU）包含一系列广泛的眼部临床表现，这使得其诊断具有挑战性。眼科医生通常需要调查证据来证实或支持TBU的临床诊断。由于眼部分泌物样本量小，从眼部标本中直接分离出致病微生物存在局限性，因此检测阳性率较低。免疫诊断测试，包括结核菌素皮肤试验和干扰素-γ释放试验（IGRAs），有助于支持TBU的临床诊断。与结核菌素皮肤试验不同，IGRAs是只需就诊一次的检测方法，且不受先前卡介苗接种的影响。目前，可用的IGRAs由不同的技术和解读方法组成。此外，新一代产品已经研发出来以提高检测活动性结核病的敏感性和能力。这篇叙述性综述整理了一些重要的实践要点，作为普通眼科医生的参考，比如在疑似TBU患者中使用IGRAs的证据，并总结了这些检测在临床环境中的基础知识和临床应用细节。
