Intraocular Tuberculosis

Reema Bansal; Aman Sharma; Amod Gupta

Disclosures

Expert Rev Ophthalmol. 2012;7(4):341-349. 

In This Article

Treatment

Tuberculostatic drugs are able to treat latent TB and decrease a person's lifetime risk of developing active TB by 90%.[77] As per the recommendations of the American Thoracic Society, the CDC and the Infectious Diseases Society of America for pulmonary and extrapulmonary TB, four drugs (isoniazid, rifampicin, ethambutol and pyrazinamide) are prescribed initially for 8 weeks, followed by isoniazid and rifampicin for at least 18 weeks.[78] This regimen is recommended irrespective of the geographic location of the patient. Pulmonary TB patients who show drug resistance are generally switched to alternate regimens based on culture reports. However, there are presently no guidelines for patients with intraocular TB who are nonresponders to the standard therapy. Moreover, despite reports of beneficial effects of ATT in intraocular TB, there are no randomized trials for optimizing the therapeutic regimen of ATT in intraocular TB.[79] As recommended by the CDC for TB of any site with slower response to therapy, a prolonged therapy is advocated for intraocular TB.[80] In a recent retrospective study, a duration of more than 9 months of anti-TB treatment was found to be associated with an 11-fold reduction in the likelihood of recurrence in patients with uveitis and latent TB.[81] Patients with uveitis requiring ATT should be treated under supervision by an infectious disease expert in view of the known hepatic toxicity of the anti-TB drugs.

Corticosteroids (topical and/or oral) are administered initially to control the inflammation, and then tapered and stopped over 6–12 weeks. Immunosuppressive agents may be added sparingly as these may interfere with the efficacy of the antibiotics.

Paradoxical worsening of lesions during anti-TB treatment, although more common in HIV-infected patients, may also be seen in HIV-negative individuals. Paradoxical worsening of choroiditis lesions may be seen on anti-TB treatment.[37,82] Adding or increasing corticosteroid therapy resolves the paradoxical reactions.[83]

processing....