Clinical spectrum of tuberculous optic neuropathy

Journal of Ophthalmic Inflammation and Infection - Tập 2 - Trang 183-189 - 2012
Ellen J. Davis1, Sivakumar R. Rathinam2, Annabelle A. Okada3, Sharon L. Tow4, Harry Petrushkin5, Elizabeth M. Graham5, Soon-Phaik Chee4, Yan Guex-Crosier6, Eva Jakob7, Ilknur Tugal-Tutkun8, Emmett T. Cunningham9,10, Jacqueline A. Leavitt11, Ahmad M. Mansour12, Kevin L. Winthrop1,13,14, William L. Hills1, Justine R. Smith1,15
1Casey Eye Institute, Oregon Health & Science University, Portland, USA
2Department of Ophthalmology, Aravind Eye Hospital, Madurai, India
3Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
4Singapore National Eye Centre, Singapore, Singapore
5Department of Ophthalmology, St. Thomas' Hospital, London, UK
6Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
7Interdisciplinary Uveitis Center, University of Heidelberg, Heidelberg, Germany
8Department of Ophthalmology, Istanbul University, Istanbul, Turkey
9Department of Ophthalmology, California Pacific Medical Center, San Francisco, USA
10Department of Ophthalmology, Stanford University, Palo Alto, USA
11Department of Ophthalmology, Mayo Clinic, Rochester, USA
12Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
13Department of Medicine, Oregon Health & Science University, Portland, USA
14Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, USA
15Department of Cell and Developmental Biology, Oregon Health & Science University, Portland, USA

Tóm tắt

Tuberculous optic neuropathy may follow infection with Mycobacterium tuberculosis or administration of the bacille Calmette–Guerin. However, this condition is not well described in the ophthalmic literature. Ophthalmologists, identified through professional electronic networks or previous publications, collected standardized clinical data relating to 62 eyes of 49 patients who they had managed with tuberculous optic neuropathy. Tuberculous optic neuropathy was most commonly manifested as papillitis (51.6 %), neuroretinitis (14.5 %), and optic nerve tubercle (11.3 %). Uveitis was an additional ocular morbidity in 88.7 % of eyes. In 36.7 % of patients, extraocular tuberculosis was present. The majority of patients (69.4 %) had resided in and/or traveled to an endemic area. Although initial visual acuity was 20/50 or worse in 62.9 % of 62 eyes, 76.7 % of 60 eyes followed for a median of 12 months achieved visual acuities of 20/40 or better. Visual field defects were reported for 46.8 % of eyes, but these defects recovered in 63.2 % of 19 eyes with follow-up. Visual recovery from tuberculous optic neuropathy is common, if the diagnosis is recognized and appropriate treatment is instituted. A tuberculous etiology should be considered when evaluating optic neuropathy in persons from endemic areas.

Tài liệu tham khảo

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