Original article
Ocular Signs Predictive of Tubercular Uveitis

https://doi.org/10.1016/j.ajo.2009.11.020Get rights and content

Purpose

To determine ocular signs predictive of tubercular uveitis.

Design

Retrospective, nonrandomized, comparative interventional case study.

Methods

Three hundred eighty-six patients with active uveitis were treated at a tertiary care single-center uveitis practice. Uveitis was presumed to be tubercular in patients who showed evidence of latent or manifest tuberculosis without any other known cause and who did not show recurrence of uveitis after 12 months of antitubercular therapy. One hundred eighty-two patients who thus obtained clinical diagnoses of presumed tubercular uveitis were enrolled in group A. Two hundred four patients with uveitis resulting from a nontubercular cause were enrolled in group B. Patients were monitored for the presence of types of keratic precipitates (mutton fat or fine), posterior synechiae (broad based or filiform), iris nodules, snowballs, snow banking, vasculitis (with or without choroiditis), serpiginous-like choroiditis, and other types of posterior uveitis (choroidal abscess, retinochoroiditis, or exudative retinal detachment) which were compared between the 2 groups. Statistical analysis was carried out at a 5% level of significance. The main outcome measures were clinical signs significantly associated with tubercular uveitis.

Results

Broad-based posterior synechiae, retinal vasculitis with or without choroiditis, and serpiginous-like choroiditis were seen significantly more commonly in patients with tubercular uveitis. Filiform posterior synechiae were more frequent in eyes with nontubercular uveitis.

Conclusions

Broad-based posterior synechiae, retinal vasculitis with or without choroiditis, and serpiginous-like choroiditis in patients with latent or manifest tuberculosis in tuberculosis-endemic areas are suggestive of a tubercular cause of uveitis and merit specific treatment.

Section snippets

Methods

We conducted a retrospective chart analysis of all consecutive uveitis patients attending the uveitis clinic of our institution between 1991 and 2005. Institutional ethics committee approval was obtained. We compared clinical signs between 2 groups of patients. Group A included patients with a diagnosis of presumed TB uveitis. Group B, which served as the control group, included patients with uveitis presumed to be of nontubercular origin. Patients with the following inclusion criteria were

Results

There were 182 patients in group A, with 95 males and 87 females. Group B had 204 patients, with 101 males and 103 females. During the same period, an additional 134 patients were diagnosed with presumed TB uveitis but were not included in group A, because they did not fulfill the inclusion criteria, that is, less than 1 year of follow-up (92 patients), intolerance or adverse side effects to antitubercular therapy (14 patients), and poor compliance (28 patients). Likewise, 74 patients with

Discussion

Uveal involvement in TB has been recognized for a long time. Choroidal tubercles, identical to tubercles elsewhere in the body, were one of the earliest signs described in miliary TB.8 Over the years, the clinical spectrum of tubercular uveitis has widened and includes anterior uveitis typically presenting as granulomatous uveitis with or without iris nodules or uncommonly as nongranulomatous inflammation, intermediate uveitis, ciliary body tuberculoma, and posterior uveitis commonly in the

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