Primer Consenso Chileno de Grupo de Estudio de Tuberculosis Ocular / First Chilean Consensus Document of the Ocular Tuberculosis Study Group

INTRODUCCIÓN: El tratamiento de la tuberculosis (TB) ocular es un tema que genera controversia en el mundo. Para el correcto manejo de estos pacientes, es necesario el desarrollo de guías que consideren la epidemiología de la TB ocular en cada nación. El objetivo de este consenso fue discutir de forma interdisciplinaria la epidemiología, fisiopatología, clínica, diagnóstico, estudio y tratamiento de los pacientes con TB ocular, para establecer un algoritmo de tratamiento y proponer qué pacientes deben ser tratados en Chile y con qué tratamiento. Además, se establecieron acuerdos para efectuar quimioprofilaxis de los pacientes con TB latente que tienen indicación de tratamiento inmunosupresor por enfermedades inflamatorias oculares.

The treatment of ocular tuberculosis (TB) remains controversial worldwide. The development of guidelines for ocular TB can facilitate the approach and management of these patients. These guidelines should be developed regionally, considering the local TB epidemiology. The objectives of this consensus are: to initiate an interdisciplinary discussion about the epidemiology, pathophysiology, clinical presentation, diagnosis, workup and treatment of patients with ocular TB, to establish a treatment algorithm and define which patients should be treated in Chile and how and, to analyze and discuss the published data regarding chemoprophylaxis for patients with latent TB who need to start immunosuppressive treatment due to inflammatory ocular conditions.

The impact of ocular tuberculosis on vision after two months of intensive therapy

ABSTRACT Tuberculosis is an infectious disease of global importance with major economic and social burden accounting for 25% of all avoidable deaths in developing countries. Extrapulmonary involvement may occur either in association with clinically apparent pulmonary tuberculosis or in isolation. This cross-sectional descriptive study aimed to evaluate the impact of ocular tuberculosis in visual acuity at baseline and after two months of intensive anti-tuberculous therapy. A sample of 133 pulmonary tuberculosis patients, seven disseminated tuberculosis, and three pleural tuberculosis patients was evaluated. All patients underwent routine ophthalmic evaluation, including assessment of visual acuity, biomicroscopy, applanation tonometry, indirect ophthalmoscopy, and fluorescent angiography as appropriate. None of the patients had impaired visual acuity due to tuberculosis. A rate of 4.2% (6/143) of ocular involvement was found. None of the patients with ocular involvement were HIV-infected. Of the six patients with ocular involvement, five met the diagnostic criteria for probable and one for possible ocular lesions. As for the type of ocular lesions, two patients had bilateral findings: one had sclerouveitis and the second had choroidal nodules. The other four patients presented with unilateral lesions: peripheral retinal artery occlusion in the right eye (one case), choroidal nodules in the left eye (one case), and choroidal nodules in the right eye (two cases). Patients progressed favorably after two month of intensive therapy, with no significant reduction in vision.

Uveite tuberculosa: a propósito de 5 casos / Tuberculosis uveitis: a five-case report

Tuberculose é rara nos paises desenvolvidos (9,3/100000 nos EUA). Entretanto com o surgimento do vírus da imunodeficiência adquirida (HIV) a incidência tem aumentado. O diagnóstico definitivo de retinocoroidite tuberculosa requer demonstraçäo do bacilo nos tecidos e fluidos oculares e, portanto, o diagnóstico é usualmente presuntivo baseado em: 1) lesäo compatível no fundo de olho; 2) eliminaçäo de outras etiologias; 3) coexistência de infecçäo tuberculosa; 4) teste de Montoux positivo; 5) resposta clínica a teste terapêutico. Säo apresentados 5 casos com perda de visäo secundária a uveite tuberculose näo relacionada à AIDS. Os pacientes foram tratados com sucesso por uma associaçäo de pirazinamida 2g qD 2m, rifampicina 600mg qD 6m, e isoniazida 400mg qD 12m. Uma boa resposta, com melhora na acuidade visual ou reduçäo significativa na reaçäo inflamatória, foi obtida já no primeiro mês de tratamento. Enfatiza-se que tuberculose ainda é comum em diversas regiöes: no estado do Rio Grande do Sul a incidência é de 31/100000; na Asia e Africa é de 110 e 165/100000 respectivamente. Uveite tuberculosa deveria ser mais diagnosticada nessas regiöes