Diagnosis of tuberculosis uveitis

Abstract

AbstractPurpose Tuberculosis uveitis are difficult to diagnose because of their polymorphism of clinical presentations. As a consequence, a diagnostic delay is often observed in this pathology. The goal of this study is to determine the clinical features and the investigations leading to the diagnosis of tuberculosis uveitis.Methods It is a retrospective study at the Saint Roch University Hospital in Nice. We followed eight patients (thirteen eyes) between September 1997 to March 2011, who presented with unilateral or bilateral tuberculosis uveitis.Results A slit‐lamp examination revealed an anterior uveitis in twelve eyes. Six eyes presented granulomatous keratoprecipitates, five had posterior synechia. Funduscopy showed twelve eyes with vitritis, seven eyes presented snowball vitreous opacities, and four eyes were affected by a papillitis. Optical coherence tomography showed a macular oedema in six eyes. Fluorescein angiography revealed five cases of retinal vasculitis. We observed three exsudative retinal detachments, and four choroidal or retinal granulomas. Five tuberculin skin test were performed, and four were positive. Three interferon‐gamma release assays were realized, and were all positive. Six analysis of aqueous humor were negative, one vitreous sample was negative. All the patients were treated with anti‐tuberculosis therapy as well as systemic steroids with a favorable clinical outcome without any recurrences observed.Conclusion Our case series shows that tuberculosis uveitis were mostly anterior granulomatous uveitis, associated with an intermediate uveitis. Some patients presented a posterior affection. Tuberculin skin test and interferon‐gamma release assays were efficient tests while analysis of intraocular fluid was less helpfull.