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Intraocular Tuberculosis

Intraocular Tuberculosis. Mamta Agarwal Senior Consultant Uveitis & Cornea Services Sankara Nethralaya Chennai. Ocular history. 32 yr / M OD - C/O blurred vision x 4 months. General H istory. H /O fever, loss of hearing, weight & appetite since 2 months

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Intraocular Tuberculosis

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  1. Intraocular Tuberculosis Mamta Agarwal Senior Consultant Uveitis & Cornea Services SankaraNethralaya Chennai

  2. Ocular history • 32 yr/ M • OD - C/O blurred vision x 4 months

  3. General History • H/O fever, loss of hearing, weight & appetite since 2 months • Diagnosed as Tubercular Meningitis • Current Treatment • Oral antitubercular therapy

  4. Clinical Presentation BCVA OD – CF1m OS – 6/6 SLE OD – AC quiet, vit cells+ OS - normal

  5. First Examination - Fundus OD OS Choroidal granuloma with exudative retinal detachment Healed choroidal granuloma

  6. HRCT chest MRI brain Miliary tuberculosis

  7. Management • Investigations • ESR – 60 mm I hr • HRCT chest – S/O miliary Tuberculosis • MRI brain –Multiple tuberculoma in brain parenchyma • U/S • Retinochoroidal elevation with exudative RD • Treatment Oral steroid & Antitubercular therapy

  8. Follow up 2 months • BCVA • OD – CF1m • OS – 6/6

  9. Final Diagnosis Tubercular Choroidal granuloma

  10. Ocular Tuberculosis • Extra pulmonary tuberculosis – Pleura, lymphnodes, liver, kidney, CNS, eyes. • Mechanism of disease • Hematogenous spread • Hypersensitivity reaction with distant focus of infection • Most common clinical manifestations • Choroidal mass 34% • Choroiditis/ chorioretinitis 27% • Vitritis 24% • Iridocyclitis 13% • Panuveitis 11% • Others – conjunctivitis, interstitial keratitis, scleritis, ocular adnexa & orbit involvement

  11. Discussion • Diagnosis of ocular TB is a diagnostic challenge. • Definite diagnosis – PCR/ Culture • Presumed Ocular Tuberculosis • Clinical history & findings • Ancillary tests • Therapeutic trial of anti tuberculosis treatment • No single, safe, sensitive, specific test exists. • Diagnostic tests like aqueous paracentesis or vitreous tap have lower sensitivities & risk of complications.

  12. Conclusion • HRCT chest is more sensitive & specific than X rays. • Mantoux test has limited sensitivity. • False positive in patients with non tuberculous mycobacterial infection & post BCG vaccination. • False negative in immunocompromised states. • Quantiferon tests fails to distinguish between active & latent infection. Useful in immunocompromised states, smear negative pulmonary TB. • PCR tests – Highly specific, low sensitive, invasive procedure.

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