眼睛结核病是全世界面临的挑战,关于它的病理生理学一直在争论,诊断,和治疗。本研究代表了一项干预性前瞻性研究,重点是可变的临床表现,眼结核的诊断和治疗特点。9例15只眼被诊断为眼结核,治疗,并在2010年至2020年期间跟进。诊断基于(1)一致的临床表现,(2)高阳性结核菌素皮肤试验或阳性IGRA试验(干扰素-γ释放试验),(3)对无全身性类固醇的抗结核药物的反应剧烈。平均年龄41.22±13.64岁,8例女性占89.8%,一名男性11.1%。只有1例先前存在肺结核。三分之二的病例发生双侧眼部受累(66.7%)。最常见的临床表现是中度葡萄膜炎(33.3%),其次是多灶性脉络膜炎(20%)。所有病例均治愈,随访2-10年无复发,口服抗结核药物6-12个月后。没有全身使用类固醇,只有局部类固醇滴剂,如所示。总之,眼结核是一种具有广泛临床表现的神秘疾病,在任何类型的眼内炎症的鉴别诊断中都应考虑,或任何无法解释的视力下降。口服抗结核药物有或没有局部类固醇足以改善视力,产生,治愈,并防止复发。
Tuberculosis of the eye represents a challenge throughout the world, and there is a continuous debate about its pathophysiology, diagnosis, and treatment. The present research represents an interventional prospective study focusing on the variable clinical presentations, and the diagnostic and therapeutic characteristics of ocular tuberculosis. Fifteen eyes from nine cases were diagnosed with ocular tuberculosis, treated, and followed up between 2010 and 2020. The diagnosis was based on (1) a compatible clinical picture, (2) highly positive Tuberculin skin test or a positive IGRA test (Interferon-Gamma Release Assays), (3) a dramatic response to anti-tuberculous drugs without systemic steroid. Mean age was 41.22±13.64 years; eight cases were females 89.8%, one male 11.1%. Only one
case had preexisting pulmonary tuberculosis. Bilateral ocular involvement occurred in two thirds of cases (66.7%). The most common clinical presentation was intermediate uveitis (33.3%), followed by multifocal choroiditis (20%). All cases were cured without relapse for the 2-10 years of follow-up, after taking oral anti-tuberculous drugs for 6-12 months. No systemic steroids were given, only topical steroid drops, as indicated. In conclusion, ocular tuberculosis is a mysterious condition with a wide-range of clinical presentations and should be considered in the differential diagnoses of any type of intraocular inflammation, or any unexplained reduction in vision. Oral anti-tuberculous drugs with or without topical steroids are sufficient to improve vision, produce, cure, and prevent relapse.