关键词: 结核,眼, 葡萄膜炎,后, 疾病特征

Abstract:

Objective: To investigate the clinical characteristics of tuberculous posterior uveitis. Methods: A retrospective study was conducted in 18 patients diagnosed of tuberculous posterior uveitis in Hebei Chest Hospital from May 2018 to June 2020. All the patients accepted standardized treatment and the clinical data were collected, the clinical characteristics were descriptively analyzed. Results: The 18 patients were all newly treated,and 16 cases had delayed visit of 14-90 days. Only 1 patient had a history of close contact to tuberculosis. According to the multimodal examination of OCT, FFA and fundus photography, they were diagnosed as choroidal nodules (n=8, 44.4%), choroidal tuberculoma (n=5, 27.8%), subretinal abscess (n=3, 16.7%) and creeping choroiditis (n=2, 11.1%). The erythrocyte sedimentation rate increased in 16 cases (88.9%); T-SPOT TB test was found positive in 18 cases; as to PPD test, 9 cases were generally positive (mean diameter of induration 10-19 mm) and 9 cases were strongly positive (mean diameter of induration ≥20 mm); of the 5 cases tested with mNGS in the aqueous humor, the diagnosis was confirmed in one pregnancy case by detecting Mycobacterium tuberculosis. Of the 12 cases (66.7%) who complicated with hematogenous disseminated pulmonary tuberculosis, 7 were also complicated with tuberculous meningitis, 2 were complicated with spinal tuberculosis, 2 were complicated with splenic tuberculosis, and 1 was complicated with brain tuberculoma; of them, 7 were positive for acid fast bacilli sputum smear, 6 cases were positive for GeneXpert MTB/RIF in diseased tissue, and the pathology of spine and spleen were positive. There were 6 cases (33.3%) were with simple eye lesions, without any general symptoms, and the main symptom was decreased vision; the visual acuity of 3 patients with macular lesions decreased seriously, and the diagnosis was made after tuberculosis, ophthalmic related examination and experimental anti-tuberculosis treatment were effective. For 16 patients treated with anti-tuberculous drugs combined with corticosteroids, and 2 patients who complicated with choroidal neovascularization and treated with anti-tuberculous drugs combined with glucocorticoids, as well as anti-neovascular endothelial growth factor, the visual acuity was improved and stabilized. Conclusion: Tuberculous posterior uveitis always has no related contact and treatment history of tuberculosis, and it is easy for it to delay visit and miss diagnosis. Ophthalmic multimodal imaging examination is helpful to the clinical classification of tuberculous posterior uveitis. Tuberculosis related examination is of great significance to the diagnosis of tuberculous posterior uveitis. Molecular biology and pathological examination can help to find the etiological basis, and systemic imaging examination can early detect the spread of tuberculosis. Anti-tuberculous drugs combined with corticosteroids have good therapeutic effect. If necessary, anti-neovascular endothelial growth factor drugs can be injected into vitreous cavity.

Key words: Tuberculosis,eye, Uveitis,posterior, Disease attributes