Regional study on the management and coutcomes of Tuberculous Uveitis

Abstract

Background: Managing suspected TB Uveitis remains challenging for TB physicians. We explored management of these cases in Sandwell and West Birmingham hospitals Trust; a tertiary ophthalmology centre in an area with high disease burden. Method: Retrospective analysis of medical notes, from 2013-2018, of individuals who received Anti tuberculous therapy (ATT) for TB uveitis. We looked at: further imaging arranged at TB clinic; its influence on management; total duration of ATT; whether corticosteroid therapy was co-prescribed; and outcome. Stable uveitis was defined as either apparent improvement, stable Intra ocular pressure (IOP) or not required further treatment. This was based on ophthalmic assessments: slit lamp examination of the anterior chamber done 6 months after end of ATT and IOP measurement. Results: Sample=40. 26 were Males. Mean Age 46, SD 13.7. 2 patients were lost to follow up while 2 are awaiting opthalmic review. 36 were included in Fisher exact test. 15 out of 36 (42%) received 6 months of ATT without corticosteroids and showed remission. A noticeable but statistically insignificant finding (p value = 0.118 Fisher exact test). All patients had a chest x-ray. 8/40 (20%) patients had CT thorax. 3 had endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) in which histology confirmed granulomatous inflammation in 3 cases - Mycobacterium Tuberculosis was isolated in 1. In conclusion: Collaboration between physicians and opthalmologists positively influenced outcome of uveitis. 6 months of ATT may be sufficient to control TB uveitis.