Tubercular Retinal Vasculitis: Diagnostic Dilemma and Management Strategies

Abstract

Ocular tuberculosis (OTB) is a rare, extrapulmonary manifestation of systemic TB, which has been a global etiology of uveitis for centuries, though concentrated in the developing world. OTB remains difficult to diagnose clinically despite a plethora of conventional and modern investigations. Tubercular retinal vasculitis (TRV) is a common and specific presentation of OTB but is variably defined in the literature in terms of clinical profile and the investigations essential for diagnosis and treatment. Ironically, the need and duration of antitubercular treatment is uncertain for this manifestation of ocular TB. The rationale and utility for corticosteroids is similarly equivocal for TRV. This review attempts to tease out a commonsense approach from the best available evidence and consensus in the literature to suspect, investigate and diagnose TRV with reasonable certainty, and institute appropriate treatment with due ethnic and geographic considerations.

Ocular Tuberculosis in Pediatrics: A Case Report

“…5 A inflamação intraocular existente pode resultar em fenómenos de vasculite retiniana, potencialmente culminando, quando não adequadamente tratados, no descolamento tracional da retina e fenómenos de neovascularização. 10 A colheita de material para estudo micobacteriológico deve ser realizada sempre que possível, uma vez que o diagnóstico definitivo depende do isolamento do Mycobacterium tuberculosis. 1,3 Contudo, as amostras necessárias para este isolamento (humor vítreo, humor aquoso ou retina) são de difícil colheita, implicando procedimentos invasivos não completamente inócuos para o doente, para além de evidenciarem baixa sensibilidade.…”

Diagnosis and biomarkers for ocular tuberculosis: From the present into the future

“…It is hypothesized that Mtb -laden macrophages deposit in the first available capillary beds upon entering the eye, which most likely is the highly vascularized choroid, creating an oxygen rich environment analogous to the apex of the lung 13 . These characteristics likely account for the fact that posterior uveitis is the most common presentation of OTB 14 .…”

“…The clinical presentation of tubercular retinal vasculitis can be variable, (1) as an exudative, segmental, hemorrhagic retinal vasculitis, usually associated with peri- or sub-vascular choroiditis, and vitritis, or (2) as a peripheral, minimally exudative, non-hemorrhagic, isolated retinal vasculitis with extensive (not segmental) swathes of pipestem-like sheathing with minimal or no vitritis. The latter is also referred to as “Eales disease” and is proposed to be more related to a hypersensitivity response to tubercular protein, hence proving the presence of Mtb may be difficult in this condition and the diagnosis is mainly based on immunoreactivity to TB antigen 14 .…”