Abstract

Volume.125 Number.4

Original article : Clinical science

Tubercular Uveitis: a Study of Clinical Features and Treatment
Asumi Tada1, Chiharu Iwahashi2, Kei Nakai2, Kenichi Namba3, Annabelle A. Okada4, Hiroshi Keino4, Hiroshi Takase5, Shoko Fukuda5, Hiroshi Goto6, Yoshihiko Usui6, Toshikatsu Kaburaki7, Nobuhisa Mizuki8, Atsushi Azumi9, Koh-Hei Sonoda10, Atsunobu Takeda11, Nobuyuki Ohguro12
1 Department of Ophthalmology, Osaka Medical Center
2 Department of Ophthalmology, Osaka University Graduate School of Medicine
3 Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
4 Department of Ophthalmology, Kyorin University School of Medicine
5 Department of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
6 Department of Ophthalmology, Tokyo Medical University
7 Department of Ophthalmology, University of Tokyo School of Medicine
8 Department of Ophthalmology and Micro-technology, Yokohama City University Graduate School of Medicine
9 Division of Ophthalmology, Department of Surgery Related, Kobe University Graduate School of Medicine
10 Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University
11 Department of Ophthalmology, Graduate School of Medical Science, Kyushu University
12 Department of Ophthalmology, Japan Community Health care Organization Osaka Hospital

Purpose: To examine the clinical features and treatment of tubercular uveitis (TBU) in Japan.
Subjects and methods: This retrospective multi-institutional cohort study included 130 patients (192 eyes) diagnosed with TBU between January 2001 and December 2012. The patients were analyzed on the basis of age, gender, clinical findings, method of examination for tuberculosis (TB), and treatment.
Results: Records of 130 patients (192 eyes) with TBU were analyzed. Patients had a mean age of 48.5±16.7 years (range 20-88 years), 78 (60%) were males, and 52 (40%) were females. Anterior uveitis was present in 11 eyes (5.7%), posterior uveitis was present in 92 eyes (47.9%), and panuveitis was present in 88 eyes (45.8%). The most common ocular findings at diagnosis was retinal vasculitis in 142 eyes (74.0%), followed by vitreous opacity in 89 eyes (46.4%), anterior chamber inflammation in 88 eyes (45.8%), and retinal exudates in 73 eyes (38.0%). Tuberculin skin test in 123 patients (94.6%) and interferon-gamma release assay (IGRA) in 83 patients (63.8%) were the most frequently performed tests for TB infection, with positive rates of 95.2% and 75.9%, respectively. Antitubercular therapy (ATT) was prescribed in 108 patients (83.1%), among which 41 patients (31.5%) received oral steroid treatment concomitantly. Concurrence of systemic TB was noted only in 14 patients (10.8%).
Conclusions: The most common clinical features of TBU were retinal vasculitis and vitreous opacity. Patients with systemic TB accounted for only about 10% of the patients included in our study. Therefore, tuberculin skin test and IGRA test were meaningful for diagnosis of TBU with various clinical presentations.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 415-424, 2021.

Key words
Tubercular uveitis, Tuberculin skin test, Interferon-gamma release assay
Reprint requests to
Asumi Hayashi, M. D.　Department of Ophthalmology, Minoh City Hospital. 5-7-1 Kayano, Minoh-shi 562-0014, Japan
Received: 29 May 2020. Accepted in revised form: 5 October 2020.
Nihon Ganka Gakkai Zasshi 125: 415-424,2021