Putera Ikhwanuliman, Thiadens Alberta A H J, Larasmanah Alamanda Siti Nurhasanah, La Distia Nora Rina, Dik Willem A, van Hagen P Martin, Rombach Saskia M, Ten Berge Josianne C E M
Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Internal Medicine Section Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Eye (Lond). 2025 Feb;39(3):593-601. doi: 10.1038/s41433-024-03577-1. Epub 2025 Jan 7.
To describe clinical features, treatment strategies and visual acuity changes of eyes with uveitic macular oedema (UMO) in ocular tuberculosis (OTB) patients from a non-TB-endemic country.
This retrospective study was conducted using a 10-year period registry of OTB patients diagnosed in Erasmus MC, Rotterdam. Longitudinal analysis of visual acuity trajectory in eyes with and without UMO was performed using linear mixed effect model.
Out of 93 included patients, 23 (24.7%; 26 eye episodes) presented with baseline UMO. Older age (p = 0.024) and diabetes coexistence (p = 0.048) were associated with UMO. Eyes with baseline UMO showed lower presenting best-corrected visual acuity (BCVA) (p = 0.024). Posterior uveitis (p = 0.005), the presence of active vitreous cells (p = 0.016) and retinal vasculitis (p = 0.008) were ocular signs associated with UMO. A step-wise treatment approach primarily initiated with local steroids, followed by a combination with oral acetazolamide and, if necessary, additional systemic immunosuppressants. Overall, this approach resulted in complete UMO resolution in 77% (20/26) of cases. UMO resolution was shorter among eyes co-managed with ATT, although statistically not significant (p = 0.144). Eyes experiencing at least one UMO episode exhibited lower visual acuity at the last-follow-up than those without (p = 0.020).
Active vitreous cells, retinal vasculitis and posterior uveitis are associated with UMO among OTB patients. The time-to-resolution of UMO for eyes co-managed with ATT was shorter compared to those without, suggesting that patients with UMO in OTB should be treated with ATT.
描述来自非结核病流行国家的眼结核(OTB)患者葡萄膜炎性黄斑水肿(UMO)眼的临床特征、治疗策略和视力变化。
本回顾性研究使用了鹿特丹伊拉斯姆斯医学中心诊断的OTB患者的10年登记资料。采用线性混合效应模型对有和无UMO的眼睛的视力轨迹进行纵向分析。
在纳入的93例患者中,23例(24.7%;26眼次)出现基线UMO。年龄较大(p = 0.024)和并存糖尿病(p = 0.048)与UMO相关。基线有UMO的眼睛初始最佳矫正视力(BCVA)较低(p = 0.024)。后葡萄膜炎(p = 0.005)、活动性玻璃体细胞的存在(p = 0.016)和视网膜血管炎(p = 0.008)是与UMO相关的眼部体征。一种逐步治疗方法主要从局部使用类固醇开始,随后联合口服乙酰唑胺,必要时加用其他全身免疫抑制剂。总体而言,这种方法使77%(20/26)的病例UMO完全消退。与抗结核治疗(ATT)联合管理的眼睛中UMO消退时间较短,尽管无统计学意义(p = 0.144)。经历至少一次UMO发作的眼睛在末次随访时的视力低于未发作的眼睛(p = 0.020)。
活动性玻璃体细胞、视网膜血管炎和后葡萄膜炎与OTB患者的UMO相关。与未联合ATT管理的眼睛相比,联合ATT管理的眼睛UMO消退时间较短,提示OTB合并UMO的患者应接受ATT治疗。