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Researchers led by Debra Goldstein of the University of Illinois at Chicago advise that mycobacterial ocular inflammation can arise without systemic or pulmonary disease and should be suspected if a patient does not respond to treatment with anti-inflammatory medication. The researchers analyzed presentations and outcomes of 17 patients (26 affected eyes) with suspected ocular mycobacterial disease, who were treated at a university uveitis clinic between 1995 and 2010.
Of the 17 patients, 14 had ocular TB and 3 had nontuberculous mycobacterial infection. Mean age of patients at presentation was 47.1 years, 11 were female, 8 were born in the United States, and 12 had possible exposure to TB. Four of 15 patients who had chest X-rays had TB disease while 5 of 9 who had chest computed tomography (CT) imaging tested positive. Chest imaging showed granulomatous disease in 46.7 of patients.
The researchers report that there was a long delay in diagnosing and treating the condition. Patients were referred to the uveitis clinic approximately 755.3 days after symptom onset and treatment was initiated 802.3 days after symptom onset. Patients’ race was associated with the delay in that Asians were referred much more rapidly than non-Hispanic patients. Posterior uveitis and a negative CT result also were associated with longer delays in referral. Patients diagnosed and treated more than 500 days after symptom onset were 20 times as likely to suffer vision loss as those diagnosed earlier. Patients more than 50 years of age also had worse outcomes.
The researchers concluded that TB must be considered as a diagnosis for ocular inflammation regardless of patient ethnicity, country of origin, or results of chest imaging; longer periods of multidrug therapy may be required to control the infection; systemic corticosteroids should be used judiciously; and a reduction in delay in diagnosis could improve the clinical outcome.
The full report, “Mycobacterial Ocular Inflammation Delay in Diagnosis and Other Factors Impacting Morbidity,” was published online in the journal JAMA Ophthalmology (2013; doi:10.1001/jamaophthalmol.2013.71).