Tülin ÇAĞATAY, Zeki KILIÇASLAN, Aylin PIHTILI, Züleyha BİNGÖL, Merih ORAY, Esen KIYAN, Gulfer OKUMUS, Penbe ÇAĞATAY, Aysen ERER, Ayse YILDIZ TAS, Ilknur TUĞAL TUTUKUN

GRANÜLOMATOZ GÖZ PATOLOJİSİ SAPTANARAK GÖZ TÜBERKÜLOZU KABUL EDİLEN HASTALARDA ANTİTÜBERKÜLOZ TEDAVİ: TÜRKİYE TEK MERKEZ DENEYİMİ

Amaç: Göz tüberkülozu hem terminoloji, hem tanı kriterleri hem de tedavi seçenekleri açısından halen tartışmalı bir konu olarak kabul edilmektedir. Yeni yaklaşımlar olmasına rağmen ortak bir tanı/tedavi algoritması bulunmamaktadır. Bu çalışmada “Göz tüberkülozu hastalarının” tedavi sonuçları değerlendirilmiştir. Gereç ve Yöntem: Latent tüberküloz enfeksiyonu olan, başka tanısı olmayan, steroid tedavisine yanıt vermeyen ve göz tüberkülozu düşünülen olgulara antitüberküloz tedavisi verildi. Bulgular: Göz tüberkülozu düşünülen ve en az üç ay süreyle antitüberküloz tedavisi gören ve düzenli takipleri yapılan 64 olgu (32 kadın, 32 erkek, ortalama 42,1±12,09 yıl) değerlendirildi. Ortalama antitüberküloz tedavi süresi 8,18±2,17 ay (3-15 ay) idi. Tedaviden sonra 64 hastanın toplam 47’si (%73,4) görmesinde iyileşme bildirdi. Bu hastaların sadece 36’sında (31 bilateral, 5 tek taraflı, toplam 67 göz) tedavi öncesi ve sonrası objektif görme değerlendirmesi yapılabildi. Bu hastalarda hastalık tutulumu 61 gözde (%91) üveit (ön, orta, arka, panüveit), 6 gözde (%9) retinal vaskülitti. Altmış yedi gözde yapılan görme analizine göre, 42 (%62,7)’sinin görme keskinliklerinde değişken düzeylerde iyileşme tespit edildi. Ortalama sağ göz görme keskinliği tedavi öncesi 0,56±0,049, tedavi sonrası 0,71±0,047 idi (p<0,001). Ortalama sol göz görme keskinliği tedavi öncesi 0,60±0,51, tedavi sonrası 0,73±0,043 idi (p<0,004). Sonuç: Latent tüberküloz enfeksiyonu varlığında göz tüberkülozu düşünülen olgularda antitüberküloz tedavisi ile başarılı sonuçlar alınabilir

Anahtar Kelimeler:

Ekstrapulmoner tüberküloz, granülomatöz göz patolojileri, göz tüberkülozu

ANTI-TUBERCULOSIS TREATMENT IN PRESUMED OCULAR TUBERCULOSIS PATIENTS WITH GRANULOMATOSIS OCULAR PATHOLOGIES: SINGLE CENTER EXPERIENCE FROM TURKIYE

Objective: Ocular tuberculosis is still considered to be a controversial issue in terms of both terminology and diagnostic criteria and treatment options. There is no common diagnostic/treatment algorithm even though new approaches exist.In this study, the results of the treatment of “presumed ocular tuberculosis patients” are evaluated. Materials and Methods: Anti-tuberculosis treatment was given to cases who had latent tuberculosis infection, had no other diagnosis and who did not respond to steroid treatment. These cases were considered to have presumed ocular tuberculosis. Results: Sixty four cases who were considered to have “presumed ocular tuberculosis” received anti-tuberculosis treatment for a minimum of three months and were followed up regularly. The 64 cases were made up of 32 women and 32 men, with a mean age of 42.1±12.09 years. Mean antituberculosis treatment duration was 8.18±2.17 months (3-15 month). After the treatment, 47 (73.4%) of 64 patients reported improvement in vision. Only 36 of these 64 cases (31 bilateral, 5 unilateral, 67 eyes in total) were evaluated with objective vision test before and after the treatment. Disease involvement was uveitis (anterior, intermediate, posterior, panuveitis) in 61 eyes (91%), and retinal vasculitis in 6 eyes (9%). According to the vision analysis among 67 eyes, 42 (62.7%), visual acuities were detected to be improved at variable levels. Mean right eye visual acuity was 0.56±0.049 before treatment, and 0.71±0.047 after treatment (p<0.001). Mean left eye visual acuity was 0.60±0.51 before treatment, and 0.73±0.043 after treatment (p<0.004). Conclusion: In the presence of latent tuberculosis infection, successful results can be obtained with antituberculosis treatment for cases diagnosed as presumed ocular tuberculosis.

Keywords:

Extra-pulmonary tuberculosis, granulomatosis ocular pathologies, ocular tuberculosis,

PDF

___

1. World Health Organization Global Tuberculosis Meeting Report, 14 October 2020. Available from: https:// apps.who.int/ iris/bitstream/handle/10665/336069/9789240013131-eng.pdf
2. T.C Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, Turkiye’de Verem Savaşı 2020 Raporu. Available from: https://hsgm.saglik.gov.tr/depo/kurumsal/yayinlarimiz/ Raporlar/Turkiyede_Verem_Savasi_2020_Raporu.pdf. Yayın No: 1205
3. Bouza E, Merino P, Muñoz P, Sanchez-Carrillo C, Yáñez J, Cortés C. Ocular tuberculosis. A prospective study in a general hospital. Medicine (Baltimore) 1997;76(1):53-61. [CrossRef]
4. Lara LP, Ocampo V Jr. Prevalence of presumed ocular tuberculosis among pulmonary tuberculosis patients in a tertiary hospital in the Philippines. J Ophthalmic Inflamm Infect 2013;3(1):1. [CrossRef]
5. Vos AG, Wassenberg MW, de Hoog J, Oosterheert JJ. Diagnosis and treatment of tuberculous uveitis in a low endemic setting. Int J Infect Dis 2013;17(11):993-9. [CrossRef]
6. Abu El-Asrar AM, Abouammoh M, Al-Mezaine HS. Tuberculous uveitis. Int Ophthalmol Clin 2010;50(2):19-39. [CrossRef]
7. Sengun A, Karadag R, Karakurt A, Saricaoglu MS, Abdik O, Hasiripi H. Causes of uveitis in a referral hospital in Ankara, Turkey. Ocul Immunol Inflamm 2005;13(1):45-50. [CrossRef]
8. Agrawal R, Gunasekeran DV, Agarwal A, Carreño E, Aggarwal K, Gupta B, et al. The collaborative ocular tuberculosis study (COTS)-1: A multinational description of the spectrum of choroidal involvement in 245 patients with tubercular uveitis. Ocul Immunol Inflamm 2018;29:1-11. [CrossRef]
9. Shakarchi FI. Ocular tuberculosis: current perspectives. Clinical Ophthalmology 2015;9:2223-7. [CrossRef]
10. Ang M, Chee S-P. Controversies in ocular tuberculosis.Br J Ophthalmol 2017;101(1):6-9. [CrossRef]
11. Lee C, Agrawal R, Pavesio C. Ocular Tuberculosis-A Clinical Conundrum. Ocul Immunol Inflamm 2016;24(2):237-42.
12. Betzler BK, Gupta V, Agrawal R. Clinics of ocular tuberculosis: A review. Clin Exp Ophthalmol 2021;49(2):146-60. [CrossRef]
13. Caspers L, Makhoul D, Ebraert H, Michel O, Willermain F. Clinical manifestations of patients with intraocular inflammation and positive QuantiFERON-TB gold intube test in country nonendemic for tuberculosis. Am J Ophthalmol 2014;158(3):646-7. [CrossRef]
14. Gupta A, Bansal R, Gupta V, Sharma A, Bambery P. Ocular signs predictive of tubercular uveitis.Am J Ophthalmol 2010;149(4):562-70. [CrossRef]
15. Ang M, Hedayatfar A, Wong W, Chee SP. Duration of anti-tubercular therapy in uveitis associated with latent tuberculosis: a case-controlstudy. Br J Ophthalmol 2012; 96(3):332-6. [CrossRef]
16. Varma D, Anand S, Reddy AR, Das A, Watson JP, Currie DC, et al. Tuberculosis: an under-diagnosed a etiological agent in uveitis with an effective treatment. Eye (Lond) 2006;20(9):1068-73. [CrossRef]
17. Tognon MS, Fiscon M, Mirabelli P, Graziani G, Peracchi M, Sattin A, et al. Tuberculosis of theeye in Italy: a forgotten extra pulmonary localization. Infection 2014;42(2):335-42. [CrossRef]
18. Lou SM, Larkin KL, Winthrop K, Rosenbaum JT, and members of Uveitis Specialists Study Group. Lack of consensus in the diagnosis and treatment for ocular tuberculosis among uveitis specialists. Ocul Immunol Inflamm 2015;23(1):25-31. [CrossRef]
19. Lou SM, Montgomery P, Larkin KL, Winthrop K, Zierhut M, Rosenbaum JT; Uveitis specialists study group. Diagnosis and treatment for ocular tuberculosis among uveitis specialists: The international perspective. Ocul Immunol Inflamm 2015;23(1):32-9. [CrossRef]
20. Pepple KL, Van Gelder R, Forooghian F. Caveats about QuantiFERON-TB goldin-tube testing for uveitis. Am J Ophthalmol 2014;157(4):752-53. [CrossRef]
21. Ang M, Nguyen HV, Kiew SY, Chen S, Chee S, Finkelstein E. Cost-effectiveness of alternative strategies for interferongamma release assays and tuberculin skin test in tuberculous uveitis. Br J Ophthalmol 2015;99(7):984-9. [CrossRef]
22. Arora SK, Gupta V, Gupta A, Bambery P, Kapoor GS, Sengal S. Diagnostic efficacy of polymerasechain reaction in granulomatous uveitis. Tuber Lung Dis 1999;79(4):229-33. [CrossRef]
23. Kataria P, Kumar A, Bansal R, Sharma A, Gupta V, Gupta A, et al. devR PCR for the diagnosis of intraocular tuberculosis. Ocul Immunol Inflamm 2015;23(1):47-52. [CrossRef]
24. Gupta A, Sharma A, Bansal R, Sharma K. Classification of intraocular tuberculosis. Ocul Immunol Inflamm 2015;23(1):7-13. [CrossRef]
25. Rosen PH, Spalton DJ, Graham EM. Intraocular tuberculosis. Eye 1990;4(Pt 3):486-92. [CrossRef]
26. Morimura Y, Okada AA, Kawahara S, Miyamoto Y, Kawai S, Hirakata A, et al. Tuberculin skin testing in uveitis patients and treatment of presumed intraocular tuberculosis in Japan. Ophthalmology 2002;109(5):851-7. [CrossRef]
27. Cimino L, Herbort CP, Aldigeri R, Salvarani C, Boiardi L. Tuberculous uveitis: A resurgent and underdiagnosed disease. Int Ophthalmol 2009;29(2):67-74. [CrossRef]
28. Bansal R, Gupta A, Gupta V, Dogra MR, Bambery P, Arora SK. Role of anti-tubercular therapy in uveitis with latent/ manifest tuberculosis. Am J Ophthalmol 2008;146(5):772-9. [CrossRef]
29. Sanghvi C, Bell C, Woodhead M, Hardy C, Jones N. Presumed tuberculous uveitis: diagnosis, management, and outcome. Eye (Lond) 2011;25(4):475-80. [CrossRef]
30. Agrawal R, Gupta B, Gonzalez-Lopez J, Rahman F, Phatak S, Triantafyllopoulou I, et al. The role of antitubercular therapy in patients with presumed ocular tuberculosis. Ocul Immunol Inflamm 2015;23(1):40-6. [CrossRef]
31. Yasaratne BM, Madegedara D, Senanayake NS, Senaratne T. A case series of symptomatic ocular tuberculosis and the response to anti-tubercular therapy. Ceylon Med J 2010;55(1):16-9. [CrossRef]