A case series of symptomatic ocular tuberculosis and the response to anti-tubercular therapy

To identify the clinical pattern of symptomatic ocular tuberculosis (OTB) and the outcome following antitubercular therapy (ATT) in an endemic setting.

A descriptive case series.

Tuberculosis and ophthalmology clinics, Teaching Hospital, Kandy, Sri Lanka.

We followed up patients with OTB on standard six-month regimen of ATT, from January 2006 to December 2008. Serial opthalmological assessment were done at the beginning and end of therapy and in each clinic visit. Relevant investigations were performed. Objective improvement of visual acuity was considered the primary clinical outcome.

Tuberculous uveitis was the commonest manifestation observed in eighteen of twenty-three patients with symptomatic OTB. Retinal vasculitis (2), episcleritis (1), optic neuritis (1) and an inflammatory scleral nodule (1) were observed in the rest. Seventeen had Mantoux positivity over 15mm. Out of the seventeen patients (age range 25-74 years; 9 males) who completed ATT, fifteen had poor pre-treatment visual acuity, which improved in nine. Keratic precipitates, anterior segment cells, flaring, vitritis and macular oedema had resolved in majority. In patients who deteriorated despite therapy, retinal vasculitis with vitreous haemorrhage (1) and branch vein occlusion (1), persistent macular oedema (2), choroidal scar (1) and optic atrophy (1) were noted.

OTB may present with varying manifestations, of which uveitis is the commonest. Majority with symptomatic OTB had a highly positive Mantoux test. Favourable clinical outcome with ATT was seen in patients who presented with uncomplicated disease. Standard regimen of ATT did not appear to be effective in patients with complications.