Ocular Tuberculosis in Pediatrics: A Case Report.

A 17-year-old male was taken to the emergency department for decreased left visual acuity and floaters beginning that same day. There was a history of exposure to pulmonary tuberculosis five years before (mother as index case) followed by a four-month period of isoniazid prophylaxis. The ophthalmic examination showed posterior and intermediate uveitis in the left eye. Laboratory tests were normal; IgG for herpes simplex 1 was positive and both the varicella-zoster virus and remaining serologic tests were negative. Chest radiography was normal. Two weeks later, an epiretinal membrane with risk of tractional retinal detachment was observed. The Mantoux tuberculin skin test showed an induration of 15 mm and the IGRA test was positive. Sputum and vitreous humor samples were collected. Quadruple therapy and prednisolone were started. Ten days later, a posterior vitreous detachment with underlying vitreous hematoma was observed. Posterior vitrectomy and peripheral endolaser were performed without complications. One month later, the microbiological results became available, with the identification of Mycobacterium tuberculosis. Corticosteroids were weaned progressively. Antituberculous drugs were maintained for six months. The patient made a full recovery.

Role of Regulatory T Cells in Tubercular Uveitis.

PURPOSE: To study the role of regulatory T cells (Tregs) in patients with tubercular uveitis. METHODS: Frequencies of peripheral Tregs, Th1, Th17 cells, and intracellular cytokines were determined in 17 tubercular uveitis patients and 18 disease controls. Function of Tregs, Th1, and Th17 cells was assessed in vitro. Simultaneously, ocular levels of IFN-γ, IL-17A, IL-4, and IL-10 were also measured. RESULTS: Frequencies of peripheral Tregs in tubercular uveitis subjects were significantly lower compared with disease controls. Furthermore, expression of TGF-ß and IL-2Rα, but not CTLA4, was reduced in Tregs of the tubercular uveitis group. The tubercular uveitis group demonstrated heightened Th1, Th17 responses following in vitro stimulation with phorbol myristate acetate (PMA)/ionomycin. Interestingly, Treg suppression assay did not show a significant difference between the two groups. Ocular levels of IFN-γ, IL-17A, and IL-10 were also elevated in tubercular uveitis group. CONCLUSIONS: Low Treg frequency and hyporesponsive function contribute to proinflammatory responses manifesting at ocular level in tubercular uveitis.

Tubercular sclerouveitis masquerading as an ocular tumor: a case report.

PURPOSE: To report the diagnosis of a case of tubercular sclerouveitis, which masqueraded as an ocular tumor. DESIGN: Case report. METHODS: Retrospective medical chart review including serological, radiological, and histopathological investigative results. RESULTS: A patient presented with recurrent episodes of sclerouveitis in his right eye. Serological investigations for infective and connective tissue disorders were negative. Radiological investigation was suggestive of a scleral perforation. The eye was enucleated and histopathological examination showed chronic inflammation. Polymerase chain reaction of the ocular tissue was positive for IS1160 for Mycobacterium tuberculosis. CONCLUSION: Infective scleritis should be suspected in cases of scleritis that progress despite treatment. Polymerase chain reaction is instrumental in diagnosing challenging cases.

[Tolerance of porous polyethylene orbital implants in children]. / Tolérance des implants orbitaires en polyéthylène poreux chez l'enfant.

INTRODUCTION: The purpose of our study is to determine the incidence of orbital complications that occurred after insertion of orbital porous polyethylene implant in children under the age of 15 years. MATERIAL AND METHODS: We report a series of 21 eyes of 21 patients younger than 15 years and in which a porous polyethylene implant is used for reconstruction of the orbital cavity after enucleation between January 2003 and December 2008.All patients were operated on by the same surgeon using the same technique. RESULTS: These 11 boys and 10 girls, whose average age is 5.7 years. Histopathologic diagnoses after enucleation are dominated by the retinoblastoma (10 eyes) and phthisis bulbi (6 eyes). After a mean follow up of 23 months it was observed two cases of implant extrusion in children enucleated for retinoblastoma. No cases of orbital cellulitis or enucleated syndrome have been reported. DISCUSSION: The most common complication of porous polyethylene implants in children is exposure. Risk factors may be related to surgical technique, infection, the implant, use of wrapping material and the association with adjuvant chemotherapy. Using a porous polyethylene implant uncovered remains an appropriate technique in children under 15 years for the reconstruction of the anophthalmic cavity, provided a rigorous surgical technique.

Primary nasolacrymal tuberculosis diagnosed after dacryocytorhinostomy.

Although tuberculosis (TB) is common and well recognized in many countries, unusual presentations of the disease sometimes raise difficulties in differential diagnosis. Primary tuberculosis of the lacrimal sac and the nasolacrimal duct is an extremely rare presentation of extra-pulmonary tuberculosis. Dacryocystorhinostomy alone is not sufficient for the treatment of these patients and an anti-tuberculous therapy has to be added. Here we present a patient with primary tuberculosis, which is limited to the inferior meatus and filled the entire lacrimal sac on the left side. The patient underwent endoscopic dacryocystorhinostomy due to obstruction of the nasolacrimal duct and culture of the granulation tissue, taken from the lacrimal sac revealed mycobacterial tuberculosis. The patient was improved with anti-tuberculous therapy that was added to the surgery. Primary tuberculosis is a rare granulomatous disease of the nasolacrimal system, which should be considered in the differential diagnosis to plan the effective treatment.

[An eleven-year experience of eye enucleation caused by severe ocular injuries]. / Akies pasalinimas po sunkiu akies traumu.

UNLABELLED: The objective of this study was to evaluate indications for primary and delayed enucleation caused by severe eye injuries. MATERIAL AND METHODS: One hundred nine enucleations performed in the Clinic of Eye Diseases of Kaunas University of Medicine Hospital during 1993-2003 years because of severe ocular injuries were analyzed retrospectively. Fifty seven of the eyes were enucleated primarily and 52 enucleations were delayed for later period. RESULTS: The most common indications for primary enucleation were: loss of internal eyeball tissues in 40 (74.1%) cases; wide tissue defect--5 (9.3%) cases; long wound--4 (7.4%) cases; endophthalmitis and panophthalmitis--5 (9.3%) cases. The most frequent indications for delayed enucleation were: endophthalmitis and panophthalmitis in 28 (59.6%) cases; atrophia and phthisis bulbi--13 (7.7%) cases; secondary glaucoma--6 (12.8%) cases. CONCLUSIONS: Amount of enucleations performed in the Clinic of Eye Diseases of Kaunas University of Medicine Hospital because of severe ocular injuries was without a significant change during ten-year period. Enucleations were performed more frequently in male patients of employable age. The most common causes for enucleation were open globe injury and penetrating wound. Loss of internal eyeball tissues, wide tissue defect, long wound, endophthalmitis and panophthalmitis were the most common indications for primary enucleation. The most frequent indications for delayed enucleation were: endophthalmitis and panophthalmitis, atrophia and phthisis bulbi, secondary glaucoma.

[Vitrectomy in treatment of ocular tuberculosis--case report]. / Witrektomia w leczeniu gruzlicy ocznej--opis przypadku.

The authors present a case of ocular tuberculosis in otherwise healthy young men, diagnosed with positive tuberculin test and positive PCR for Mycobacterium tuberculosis in conjunctiva and vitreous samples. An early vitrectomy and typical systemic treatment (tuberculostatic drugs) resulted in regression of the disease.

Tuberculous granuloma managed by full thickness eye wall resection.

PURPOSE: To report the use of eye wall resection in the management of tuberculous granuloma. DESIGN: Interventional case report. METHODS: In a 26-year-old man with biopsy-proven tuberculous granuloma of the left eye, total eye wall resection and donor scleral grafting was performed for management of tuberculous granuloma involving the sclera, part of the cornea, the iris, the chamber angle, and the ciliary body. Adjuvant therapy included oral antitubercular medication. RESULTS: The treatment of the infection was successful. The scleral graft healed well, and the crystalline lens was preserved. CONCLUSIONS: Total eye wall resection, a technique described in the management of uveal tumors, can be adopted to manage selected cases of tuberculous granuloma of the eye.

Nasolacrimal tuberculosis in a patient with conjunctivodacryocystorhinostomy.

PURPOSE: To present an unusual case of nasolacrimal tuberculosis that was diagnosed with polymerase chain reaction (PCR) and to discuss the role of PCR as a diagnostic aid. METHODS: Case presentation with diagnostic modalities including PCR, cytopathologic, and histopathologic examinations with special stains. RESULTS: A 40-year-old woman with bilateral lacrimal drainage system obstruction underwent a right dacryocystorhinostomy with stents and left conjunctivodacryocystorhinostomy with Jones bypass tube. Although the findings of direct and endoscopic examinations of the nasal cavity were within normal limits, the tissue removed during surgery from the middle turbinate revealed caseating granulomatous lesions on histopathologic examination. Acid-fast organisms were demonstrated in postoperative nasal washings, and Mycobacterium tuberculosis infection was confirmed with PCR. CONCLUSION: Primary tuberculosis of the nasolacrimal mucosa is rare, and its occurrence without any symptoms, as in this patient, is even less frequent. The most interesting aspect of this case was the identification of the M. tuberculosis DNA in the mucosa of anterior turbinate and fibrous tissue within the previous surgical site. Histopathologically, the presence of caseating granulomas was seen only in the nasal mucosa, indicating that PCR may be of use in identifying the causative organism even in the absence of typical histopathologic features.

Choroidal tuberculosis diagnosed by polymerase chain reaction. A clinicopathologic case report.

PURPOSE: To show the use of the polymerase chain reaction (PCR) in a granulomatous choroidal lesion to support a diagnosis of tuberculosis. DESIGN: Observational case report. TESTING: Nucleic acid target amplification of a choroidal specimen using PCR for detection of Mycobacterium tuberculosis was tested. MAIN OUTCOME MEASURES: Positive nucleic acid target amplification for M. tuberculosis in the ocular sample was measured. RESULTS: PCR was positive for M. tuberculosis with appropriate negative controls. CONCLUSIONS: PCR was thought to be a useful supportive technique in the diagnosis of choroidal tuberculosis.

Clinicopathologic study of satellite lesions in nontuberculous mycobacterial keratitis.

Multifocal stromal infiltrates or "satellite lesions" have been considered a characteristic feature of fungal keratitis. We examined two patients with nontuberculous mycobacterial keratitis who clinically presented with satellite lesions. The keratitis consisted of multifocal stromal infiltrates with indistinct white and fluffy margins. Both patients received topical fortified amikacin therapy with poor response. Lamellar keratectomy or penetrating keratoplasty was performed, respectively, in the two patients because of progressive stromal thinning and enlarging satellite lesions. Histopathologically, the main lesions consisted of dense infiltration of inflammatory cells with numerous acid-fast bacilli, while the satellite lesions were composed chiefly of inflammatory cells with fewer mycobacteria. Besides fungal keratitis, nontuberculous mycobacterial keratitis should also be considered when satellite lesions are present.

[Tuberculosis of the tarsal conjunctiva]. / Tuberculoza conjunctivei tarsale.

A woman sixty-five old presents one pronounced swelling of the eyelids at the both eyes with the appearance of the multiple chalasions. The patient at twenty-six years old presented pulmonary tuberculosis, in the present stabilized. The morphopathology exam by a fragment of tarsus and conjunctiva shows an lymphocyt inflammatory infiltration with the presence of the epithelial cells and caseation areas. At level of conjunctiva it constats the presence of tuberculum follicles that are present too at the level of Meibomius canals of excretions. The disease is considered like an allergical reaction at endotoxin of Koch bacillus, secondary by some old tubercular lesions.

Optochiasmatic tuberculoma--case report and review.

An optochiasmatic tuberculoma, encasing the chiasm and optic nerves, was found in a 58-year-old woman complaining of sudden beginning and progressive visual failure. The patient was treated by surgery and prolonged corticosteroids and continued triple antituberculous therapy. Pathological diagnosis was a tuberculoma confirmed by postoperative positive polymerase chain reaction against M. tuberculosis. Because the incidence of tuberculomas has increased, especially in developing countries, in recent years and they also involve optic nerves and chiasm, it is important to include optochiasmatic tuberculoma in the differential diagnosis of optic nerve and chiasm tumors. Including this case, only 31 instances of optochiasmatic tuberculoma have been reported in the literature.