Ten Pearls for Treatment of TB Uveitis
1. In TB-endemic countries, think of TB as a probable/possible etiology of uveitis in Presence of one or a few large full-thickness choroidal granulomas that show enhanced vascularity/RAP on FFA Retinal periphlebitis with subvascular retinitis/choroiditis lesions/scars that show extensive peripheral retinal ischemia. Multifocal serpiginoid choroiditis/Serpiginous-like choroiditis lesions with vitreous cells. 2. In the presence of any of the above clinical phenotypes, collect evidence of MTB infection by way of tuberculin skin test/QuantiFERON-TB Gold; X-ray/CT chest. The 2-step testing (Bayesian probability) improves the likelihood of MTB as a probable/possible etiology of uveitis in TB-endemic regions. 3. Polymerase chain reaction to detect MTB DNA from ocular fluids has low sensitivity limiting its utility in clinical practice. If positive, it confirms the diagnosis of TBU but a negative test does not rule out MTB. 4. Start 4-drug anti-TB drug regimen in consultation with an internis
Prof. Amod Gupta