To treat, or not to treat after striking gold

Matthew K. Kenworthy1, Ella Suo2, Mei-Ling Tay-Kearney3, Ruad Perera4, Josephine C. Richards5

Meeting:  2023 RANZCO


Date:      -


Session Time:      -

Purpose: To describe the clinical presentations and treatment outcomes of ocular tuberculosis in Western Australia, a low-endemic setting.
Method: A retrospective review of ocular tuberculosis cases diagnosed and treated in Western Australia from 2007 to 2018 was completed. The minimum follow-up period was two years following completion of anti-tuberculosis treatment (ATT).
Results: A total of 33 patients met the inclusion criteria, of which 96.96% were born overseas. No patients had symptomatic systemic tuberculosis outside the eye. Patients were treated with three or four anti-tuberculosis medications. Retinal vasculitis was the most common, followed by anterior, panuveitis and choroiditis serpiginous-like. Full resolution of ocular inflammation following ATT without recurrence occurred in 66.66% of patients. Partial treatment success, defined as reduced ocular inflammation without progressive chorioretinal or retinovascular damage or further vision loss, was seen in 27.27% of patients. In this subgroup, seven patients required one or more courses of topical steroids, and two patients required systemic immunosuppression. There was no improvement in ocular inflammation following ATT and systemic immunosuppression in 6.06% of patients. Jarisch-Herxheimer reaction was seen in 27.27% of patients.
Conclusion: In this setting, ATT had a full or partial success rate of 93.93%. The need for ongoing systemic immunosuppression in four patients and topical anti-inflammatory treatment in seven patients illustrates the immunological spectrum of tubercular disease in the eye thought to be either triggered by active infection, resultant from permanently post-inflammatory disrupted blood-ocular barrier, or represent an ongoing reaction to uncleared tubercular antigens.