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      Degree, duration, and causes of visual impairment in eyes affected with ocular tuberculosis

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          Abstract

          Background

          Ocular tuberculosis (TB) can affect nearly every ocular tissue, leading to a variety of vision-threatening clinical manifestations. The goal of this study is to estimate the degree, duration, and causes of visual impairment in eyes affected by ocular TB.

          Results

          This was a retrospective study of patients diagnosed as ocular TB based on polymerase chain reaction (PCR) for Mycobacterium tuberculosis complex. We applied the World Health Organization definition of visual impairment (VI) to affected eye(s), instead of better-seeing eye. Best-corrected visual acuity (BCVA) of <6/18 and ≥6/60 in the affected eye was classified as moderate VI and <6/60 and ≥3/60 as severe VI. Data collected included presenting and final BCVA of affected eyes and the worst BCVA during the study period. Sixty-one eyes of 40 patients were analyzed. Twenty-five patients (52.1%) had bilateral disease. The mean worst BCVA and mean final BCVA (logMAR) were 1.26 ± 0.87 and 0.61 ± 0.85, respectively, and their difference was highly significant ( p < 0.0001, Friedman test). The median worst and final BCVA results were 1.30 (range 0.0 to 3.0) and 0.20 (range 0.0 to 3.0), respectively. The mean duration of follow-up was 98.34 ± 81.81 weeks. Moderate and severe VIs were seen in 14 (22.9%) and 12 (19.7%) eyes, respectively, during the course of follow up. Twenty eyes (32.8%) had BCVA of <3/60. Moderate VI or worse was most commonly seen in eyes with multifocal serpiginoid choroiditis ( n = 6; 100%), retinal vasculitis ( n = 25; 80.6%), and panuveitis ( n = 12; 80%). The mean duration of visual loss was 25.2 ± 42.37 weeks (median 6.43 weeks, range 0 to 206.42 weeks). Vitreous hemorrhage, complicated cataract, and macular scarring were the common causes of VI.

          Conclusion

          Ocular TB can result in prolonged visual impairment, more commonly in patients with posterior uveitis or panuveitis.

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          Most cited references 13

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          Causes and frequency of blindness in patients with intraocular inflammatory disease.

          Uveitis, an intraocular inflammatory disease, is a significant cause of visual impairment. It is not known how many patients with uveitis will retain visual acuity and how many develop visual impairment or even blindness. The aim of this study was to assess the frequency of blindness in patients with uveitis and, more specifically, to identify the clinical profile of patients at risk for visual loss. A cross sectional and retrospective study of 582 patients with uveitis who visited the ophthalmology departments of two university hospitals in the Netherlands was performed. Within the group of 582 patients, 203 (35%) exhibited blindness or visual impairment; bilateral legal blindness developed in 22 (4%) patients, 26 (4.5%) had one blind eye with visual impairment of the other, and nine (1.5%) had bilateral visual impairment. Unilateral blindness developed in 82 (14%) patients, whereas 64 (11%) exhibited unilateral visual impairment. The most important cause of both blindness and visual impairment was cystoid macular oedema (29% and 41%, respectively). Complications of uveitis were encountered in more than half of the patients and 23% underwent one or more surgical procedures. When the patients were subdivided according to anatomical site, those with panuveitis had the worst visual prognosis. The systemic diseases associated with a poor visual prognosis were juvenile chronic arthritis and sarcoidosis. Ocular toxoplasmosis was the most frequent cause of unilateral visual loss. Cystoid macular oedema is the most frequent complication of uveitis and its occurrence plays a decisive role in the visual outcome of this disease.
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            Intraocular tuberculosis--an update.

            The lack of any uniform diagnostic criteria for intraocular tuberculosis, in either immunocompetent or immunocompromised individuals, has contributed to the confusion regarding diagnosis and management. However, recent studies addressing the clinical significance of purified protein derivative test results, computerized tomography of the chest, and molecular diagnostic procedures have provided a new approach to establishing the diagnosis of ocular tuberculosis. The current review focuses on the diagnostic modalities used for the clinical management of intraocular tuberculosis, with the emphasis on diagnostic criteria, various clinical features, and treatments recommended in recent publications. Furthermore, the current review addresses the diagnostic criteria for intraocular tuberculosis, the spectrum of tuberculosis in patients with AIDS and in those on anti-tumor necrosis factor agents, and management of drug-resistant tuberculosis.
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              The possible impact of uveitis in blindness: a literature survey.

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                Author and article information

                Journal
                J Ophthalmic Inflamm Infect
                J Ophthalmic Inflamm Infect
                Journal of Ophthalmic Inflammation and Infection
                Springer
                1869-5760
                2014
                1 February 2014
                : 4
                : 3
                Affiliations
                [1 ]LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha 751 024, India
                [2 ]Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh
                [3 ]LV Prasad Eye Institute, Hyderabad, Andhra Pradesh 500034, India
                [4 ]District Tuberculosis Center, Capital Hospital, Bhubaneswar, Odisha 751003, India
                Article
                1869-5760-4-3
                10.1186/1869-5760-4-3
                3912920
                24485195
                Copyright © 2014 Basu et al.; licensee Springer.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                Categories
                Original Research

                Ophthalmology & Optometry

                antitubercular therapy, visual impairment, ocular tuberculosis

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