Vol.:(0123456789)
1 3
Infection
https://doi.org/10.1007/s15010-018-1161-1
ORIGINAL PAPER
Early treatment of tuberculous uveitis improves visual outcome: a 10-
year cohort study
Luis Anibarro
1,2
· Eliana Cortés
3
· Ana Chouza
1
· Alberto Parata‑Fernández
4
· Juan Carlos García
1
· Alberto Pena
1
·
Carlos Fernández‑Cid
4
· África González‑Fernández
2
Received: 25 January 2018 / Accepted: 1 June 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Purpose Diagnosis of tuberculous uveitis (TBU) is often challenging and is usually made after excluding other causes of
uveitis. We analysed the characteristics of TBU and variables associated with visual outcome.
Methods A retrospective, observational analysis was performed in patients with presumptive TBU who were started on
specific TB treatment between January 2006 and June 2016. Demographic, clinical, radiological, analytical and ophthalmic
examination variables were studied. After completing TB treatment, a follow-up of at least 9 months was performed. A
univariate and logistic regression analysis was applied to identify the variables associated with visual acuity and recurrences
of uveitis.
Results Forty affected eyes of 24 individuals were identified; 79% of patients were diagnosed during the last 3 years of the
study period. Median delay from onset of symptoms to diagnosis was 12 weeks. Loss of visual acuity was the most frequent
symptom (87.5%). Posterior uveitis was the most frequent localization (72.9%); 19 patients (79.2%) presented at least one
of the Gupta signs predictive of TBU, but there were no confirmed diagnoses.
Outcome There was improvement in visual acuity in 74.4% of the eyes, but a complete response was achieved only in 56.4%.
There was recurrence in two patients. The initiation of treatment ≥ 24 weeks after onset of symptoms was significantly asso-
ciated with no improvement (p = 0.026).
Conclusion TBU can cause permanent damage to visual acuity, particularly in patients with delayed diagnosis. A prompt
initiation of systemic TB treatment is essential to improve visual prognosis.
Keywords Tuberculosis · Uveitis · Intraocular tuberculosis
Introduction
Tuberculous uveitis (TBU) is a form of extrapulmonary
tuberculosis (TB) of growing interest in recent years. Its
pathogenesis presents particular features that contrast with
other forms of TB such as the decisive involvement of an
immune response in clinical presentation and the difficulty,
or even impossibility of demonstrating M. tuberculosis in
ocular tissues [1]. Therefore, TBU is a diagnostic challenge
to both ophthalmologists and infectious diseases specialists,
and even for those experienced in TB diagnosis and treat-
ment [2, 3]. The decision to initiate TB treatment is usually
empiric, based on a combination of suggestive ocular signs
associated with clinical, analytical and radiological findings
[4, 5]. Despite growing interest, there are few TBU studies
carried out in countries with low and moderate prevalence
of TB.
* Luis Anibarro
luis.anibarro.garcia@sergas.es
1
Unidad de Tuberculosis, Enfermedades Infecciosas, Servicio
de Medicina Interna, Complexo hospitalario universitario de
Pontevedra, Instituto de Investigación Sanitaria Galicia Sur,
Rúa Loureiro Crespo, nº2, 36001 Pontevedra, Spain
2
Inmunología, Centro de investigaciones Biomédicas,
CINBIO, Centro Singular de Investigación de Galicia,
Universidad de Vigo, Campus Universitario de Vigo,
36310 Vigo, Spain
3
Servicio de Medicina Interna, Hospital universitario Ramón
y Cajal, Carretera Colmenar Viejo km 9,100, 28034 Madrid,
Spain
4
Servicio de Oftalmología, Complexo hospitalario
universitario de Pontevedra, 36001 Pontevedra, Spain
@Phil_Robichaud
@deepthiw
@JoseServera