Ocular tuberculosis in Hospital Universiti Sains Malaysia - A case series.

INTRODUCTION: Ocular tuberculosis (TB) encompasses a broad spectrum of clinical manifestations affecting different structures of the eye. It is caused by Mycobacterium tuberculosis, a great ancient organism that induces various types of diseases and unfavorable outcomes if unrecognized and not well treated. PURPOSE: To report the clinical profile of 34 ocular TB cases observed during 6 years period in Hospital Universiti Sains Malaysia (HUSM). METHOD: A retrospective review of medical records from 34 patients diagnosed with ocular TB in HUSM from January 2011 until December 2016. RESULTS: The mean age was 43 ± 14.6 years old. Both male and female affected in about 1:1 ratio. The majority of subjects were local Malays (91.2%). Risk factors included previous contact with pulmonary TB patients (38.2%), and patients with underlying diabetes mellitus (26.5%). Most patients showed normal chest radiography (79.4%). However they had positive Mantoux test (94.1%) and raised erythrocyte sedimentation rate (ESR) value (58.8%). Uveitis was the most common ocular manifestation of ocular TB (70.6%) while the rare ocular manifestations included optic perineuritis and optic neuritis, orbital apex syndrome, orbital cellulitis, sclerokeratitis, corneal ulcer and conjunctival abscess. All patients responded well to anti-TB treatment, but visual outcome was variable. CONCLUSIONS: This review shows the diverse entity of ocular TB spectrum in an endemic area. Good clinical response to anti-tuberculous therapy supported the presumed diagnosis of ocular TB in majority of the cases.

Syphilis:an under-recognized cause of postoperative uveitis in elderly / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report a case of postoperative uveitis secondary to syphilis in an elderly patient.METHODS:A 76-year-old Malay man, a case of bilateral immature cataract underwent uneventful right phacoemulsification. There was no history of uveitis before. On day 5 post operation, he developed sudden onset of vision blurring in the right eye. Examination showed generalized cornea edema with moderate anterior chamber reaction and increased intraocular pressure.RESULTS: The patient responded well to topical antibiotic and steroid. The intraocular pressure was controlled with anti-glaucoma agent. However, the patient developed similar episode of pain, redness and poor vision in the same eye after 3 weeks. Ocular examination revealed severe anterior uveitis with presence of mutton fat keratic precipitates. Venereal disease research laboratory (VDRL) and treponema pallidum hemagglutination assay (TPHA) were positive suggesting syphilis. The condition improved markedly with benzathine penicillin injection and topical steroid.CONCLUSION:This case illustrates syphilis as an under-recognized cause of postoperative uveitis in the elderly. Appropriate management with penicillin has showed rapid and remarkable outcome.