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Early treatment of tuberculous uveitis improves visual outcome: a 10-year cohort study

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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 associated 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.

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Acknowledgements

Fundación Galicia Sur Statistics Foundation for statistical support.

Funding

Without financing.

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Authors and Affiliations

  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

    Luis Anibarro, Ana Chouza, Juan Carlos García & Alberto Pena

  2. Inmunología, Centro de investigaciones Biomédicas, CINBIO, Centro Singular de Investigación de Galicia, Universidad de Vigo, Campus Universitario de Vigo, 36310, Vigo, Spain

    Luis Anibarro & África González-Fernández

  3. Servicio de Medicina Interna, Hospital universitario Ramón y Cajal, Carretera Colmenar Viejo km 9,100, 28034, Madrid, Spain

    Eliana Cortés

  4. Servicio de Oftalmología, Complexo hospitalario universitario de Pontevedra, 36001, Pontevedra, Spain

    Alberto Parafita-Fernández & Carlos Fernández-Cid

Authors
  1. Luis Anibarro
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  2. Eliana Cortés
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  3. Ana Chouza
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  8. África González-Fernández
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Corresponding author

Correspondence to Luis Anibarro.

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An institucional Review Board approval was obtained from the Comité Ético de Investigación Galicia Sur (registration code 2017/007.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Anibarro, L., Cortés, E., Chouza, A. et al. Early treatment of tuberculous uveitis improves visual outcome: a 10-year cohort study. Infection 46, 549–554 (2018). https://doi.org/10.1007/s15010-018-1161-1

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  • DOI: https://doi.org/10.1007/s15010-018-1161-1

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