Uveitic macular oedema in ocular tuberculosis patients in a non-endemic country: characteristics, management, and visual Outcomes

Abstract

Objective: To describe clinical features, treatment strategies and visual acuity changes of eyes with uveitic macular oedema (UMO) in ocular tuberculosis (OTB) patients from a non-TB-endemic country.

Methods: This retrospective study was conducted using a 10-year period registry of OTB patients diagnosed in Erasmus MC, Rotterdam. Longitudinal analysis of visual acuity trajectory in eyes with and without UMO was performed using linear mixed effect model.

Results: Out of 93 included patients, 23 (24.7%; 26 eye episodes) presented with baseline UMO. Older age (p = 0.024) and diabetes coexistence (p = 0.048) were associated with UMO. Eyes with baseline UMO showed lower presenting best-corrected visual acuity (BCVA) (p = 0.024). Posterior uveitis (p = 0.005), the presence of active vitreous cells (p = 0.016) and retinal vasculitis (p = 0.008) were ocular signs associated with UMO. A step-wise treatment approach primarily initiated with local steroids, followed by a combination with oral acetazolamide and, if necessary, additional systemic immunosuppressants. Overall, this approach resulted in complete UMO resolution in 77% (20/26) of cases. UMO resolution was shorter among eyes co-managed with ATT, although statistically not significant (p = 0.144). Eyes experiencing at least one UMO episode exhibited lower visual acuity at the last-follow-up than those without (p = 0.020).

Conclusions: Active vitreous cells, retinal vasculitis and posterior uveitis are associated with UMO among OTB patients. The time-to-resolution of UMO for eyes co-managed with ATT was shorter compared to those without, suggesting that patients with UMO in OTB should be treated with ATT.