Ocular manifestations of presumed ocular tuberculosis in patients with lung tuberculosis_Chinese Journal of Ocular Fundus Diseases

Authors：

 ZhaoHuiying , ChenDongjun , ChenJianhua , 王伟 , 吴香丽 , 刘彦 , 殷英霞

Department of ophthalmology, Beijing Geriatric Hospital, Beijing 100095, China;

Corresponding author：

ZhaoHuiying, Email: zhaohuiying19999@163.com

Keywords：

Tuberculosis,ocular/diagnosis; Tuberculosis,pulmonary/complications

DOI：

10.3760/cma.j.issn.1005-1015.2014.05.012

Video：

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Objective To observe the ocular manifestations of presumed ocular tuberculosis in patients with pulmonary tuberculosis. Methods One hundred and fifty nine patients with pulmonary tuberculosis received examinations of visual acuity, slit lamp microscopy and indirect ophthalmoscopy. Those patients with retinochoroidal inflammatory lesions, retinal hemorrhages or detachments underwent fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) to determine whether the presumed ocular tuberculosis was involved. There were 9 patients (16 eyes, 5.67%) of presumed ocular tuberculosis, including 5 males and 4 females. The age was ranged from 19 to 64 years old, with an average of 35.12 years. Seven patients were affected bilaterally and 2 patients affected unilaterally. There were 8 patients (15 eyes, 93.75%) with uveitis and 1 patient (1 eye, 6.25%) with central retinal vein occlusion (CRVO). The blood laboratory tests were negative in all cases. Results The corrected vision was from light sensation to 0.15 in 6 uveitis eyes, 0.8 to 1.0 in 10 eyes. The anterior segment change was found in 10 eyes, which including granulomatous uveitis (8 eyes) and non-granulomatous uveitis (2 eyes). Granulomatous uveitis eyes had iris nodules, posterior synechia of the iris and mutton-fat keratic precipitates (KP). Non-granulomatous uveitis eyes had KP only. Choroidal tubercles were found in 7 eyes in which 3-7 off-white lesions of varying sizes were found with local retinal detachment. FFA revealed hypo-fluorescence with obscure boundary in arterial phase and arterial and venous phase, and hyper-fluorescence with obscure boundary in later phase. OCT showed retinal pigment epithelium uplift. There was 1 eye with CRVO, which had punctate, splinter and linear hemorrhage, white lesions in some hemorrhagic focus. Conclusion The presumed ocular tuberculosis eyes showed mainly granulomatous inflammation and multiple choroid tubercles, and CRVO sometime.

Citation： ZhaoHuiying, ChenDongjun, ChenJianhua. Ocular manifestations of presumed ocular tuberculosis in patients with lung tuberculosis. Chinese Journal of Ocular Fundus Diseases, 2014, 30(5): 477-479. doi: 10.3760/cma.j.issn.1005-1015.2014.05.012 Copy

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1. Vyas S, Chandraker AK, Garge M, et al. Role of an ophthalmologist in early diagnosis and management of ocular tuberculosis. AIOC 2009 Proceedings, 2009:370-372.
2. Shree KK, Chan CC. Mycobacterium-related ocular inflammatory disease:diagnosis and management[J]. Ann Acad Med Singapore, 2006:203-209.
3. Donahue HC. Ophthalmologic experience in a tuberculosis sanatorium[J]. Am J Ophthalmol, 1967,64:742-748.
4. Biswas J, Badrinath S. Ocular morbidity in patients with active systemic tuberculosis[J]. Int Ophthalmol, 1996,19:293-298.
5. Lara LP, Ocampo V Jr. Prevalence of presumed ocular tuberculosisamong pulmonary tuberculosis patients in a tertiary hospital in the Philippines[J]. J Opthalmic Inflam and Infect,2013, 3:1-4.
6. WS288-2008中华人民共和国卫生行业标准肺结核诊断标准. 北京:人民卫生出版社,2008.
7. Gupta V,Gupta A,Rao NA.Intraocular tuberculosis:an update[J].Surv Ophthalmol,2007,52:561-587.
8. Paez Allende FS. Essential atrophy of the iris in a subject of pulmonary tuberculosis[J]. Sem Med, 1952, 101:650-653.
9. 储昭节, 惠延年. 结核性葡萄膜炎的研究进展[J]. 中华眼科杂志, 2010, 46:861-864.
10. Sheu SJ, Shyu JS, Chen LM, et al. Ocular manifestations of tuberculosis[J]. Ophthalmology, 2001, 108:1580-1585.
11. Kopsachilis N, Brar M, Marinescu AI, et al. Central nervous system tuberculosis presenting as branch retinal vein occlusion[J]. Clin Exp Optom, 2013,96:121-123.
12. Fullerton DG, Shrivastava A, Munavvar M, et al. Pulmonary tuberculosis presenting with central retinal vein occlusion[J]. Br J Ophthalmol, 2007, 91:1714-1715.
13. Mahyudin M, Choo MM, Ramli NM, et al. Ocular tuberculosis initially presenting as central retinal vein occlusion[J]. Case Rep Ophthalmol,2010,1:30-35.

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