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Tuberculous Uveitis Presenting with a Bullous Exudative Retinal Detachment: A Case Report and Systematic Literature
Ji Hun Song1,2, Anjum F Koreishi2, Debra A Goldstein2
1Department of Ophthalmology, Ajou University School of Medicine , Suwon , South Korea.
Ocular Immunology and Inflammation
|July 4, 2018
Summary
Tuberculous uveitis (TU) can present atypically as bullous retinal detachment (RD). Early diagnosis and treatment with anti-tubercular therapy and steroids improve vision outcomes.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Tuberculous uveitis (TU) is an uncommon ocular manifestation of tuberculosis.
- Atypical presentations, such as bullous retinal detachment (RD), can delay diagnosis and treatment.
- Early recognition is crucial to prevent vision loss.
Observation:
- An 84-year-old woman presented with bilateral granulomatous uveitis and bullous RD.
- Interferon gamma release assay was positive; other tests were unremarkable.
- The patient responded well to anti-tubercular therapy (ATT) and systemic steroids.
Findings:
- A literature review identified 32 cases of TU with exudative RD.
- Choroidal tuberculoma was the most frequent finding, followed by optic disc edema and retinal exudates.
- Combined ATT and systemic steroids yielded better visual outcomes (78.6%) compared to ATT alone (50.0%) or sequential treatment (50.0%).
Implications:
- A high index of suspicion for TU is necessary for atypical ocular presentations.
- Prompt diagnosis and management of TU can significantly reduce ocular morbidity.
- Integrated approaches combining anti-tubercular therapy and corticosteroids are most effective.
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