Clinical Features and Prognostic Factors in Presumed Ocular Tuberculosis

Abstract

The diagnosis of ocular TB can be difficult due to the lack of extraocular manifestations and the broad spectrum of ocular features. A longer duration of symptoms at diagnosis was associated with poorer visual outcomes and cataracts. Therefore, efforts should be made to avoid a delay in the diagnosis of ocular TB and to identify prognostic factors for visual outcomes and complications.

Clinics of ocular tuberculosis: A review

“…Prolonged evaluation and delayed referral to a uveitis specialist comes with its own set of problems. Urzua and colleagues 57 observed a positive correlation between poorer baseline visual acuity (VA) and duration of symptoms at presentation. When considering patients within COTS, Testi and colleagues 39 suggested that the finding of patients receiving corticosteroids before initiation of ATT and being resultantly affected by distinctly high rates of treatment failure could indicate a delay in the diagnosis of OTB because specific therapy could not be initiated, resulting in a worse outcome.…”

Vogt-Koyanagi-Harada Disease

“…Diagnosis of VKH involves a comprehensive ophthalmic evaluation, in order to confirm the presentation of characteristic findings described above. Importantly, the bilateral nature of the condition and the presence of panuveitis, with areas of subretinal fluid and/or retinal detachments, as well as the inexistence of evidence of alternative diseases are hallmarks of the set of standardized diagnostic criteria previously published (Table 1) [3,9,24]. In that sense, the presence of integumentary and/or neurological findings defines the category of diagnosis (probable…”

“…Despite this aggressive therapy with systemic CS, a significant proportion of VKH patients present refractoriness, remaining with active inflammation and thus requiring immunomodulatory therapy (IMT) [9]. This subset of refractory patients has better functional outcomes if an earlier IMT is indicated [9].…”

“…Therefore, an early CS-response categorization should be carried out, in order to distinguish and to separate subjects with a potential benefit of early IMT initiation. In that sense, some clinical predictive factors of GC refractoriness have been described, such as baseline VA ≤ 20/200, fundus depigmentation at diagnosis, and chronic disease, which are important facts to be considered in the context of an appropriate VKH initial evaluation [9].…”

“…Recently, significant advances have been reported regarding treatment options and novel approaches to evaluate and categorize this group of patients, in order to personalize follow-up and management in each subject and thus achieve better functional and anatomic outcomes [9].…”