"MANTOUX TESTING IN UVEITIS PATIENTS AND TREATMENT OF PRESUMED INTRAOCULAR TUBERCULOSIS IN WESTERN UP"

Tuberculosis is re-emergingasaglobalhealthproblem.Itisaslowlyprogressive,chronic,granulomatous infectioncausedbyM.tuberculosiswhichusuallyaffectslungs,butcanalsoaffectotherorganslikeCVS,GI,CNS,SKINandEYES.Choroidal tubercles and tuberculomas are reported to be the most common intraocular manifestations of TB and the mostcommonintraocularclinicalpresentationappearstobeposterioruveitis.ThediagnosisofocularTBisconsideredinsettingsof1.IsolationofM.tuberculosisfromocularfluidsortissuespecimen.Byamicrobiologicalorhistopathologicalstudy,PCR.2.AspresumedoculardiseasesuggestiveofTBwithprovensystemicactivedisease.3.Presumedoculardiseasewithoutevidenceofactivesystemicdisease.DiagnosticCriteriaForPresumedIntraocularTbUveitiswere.1.Ocular findings consistent with possible intraocular TB with no other cause of uveitis suggested by history of symptoms,orancillarytestings.2.StronglypositiveMANTOUX OR TUBERCULINSKINTESTING(>10mmareaofinduration/necrosis)3.Responsetoantituberculartherapywithabsenceofrecurrences.The aims of our study were to evaluate prevalence of Mantoux positive in newly referred uveitis patients in whom systemicevaluationwasperformedandtoassesstheoutcomeoftreatmentforpresumedintraoculartuberculosisinselectedpatients.MATERIALANDMETHOD The studywas conductedin theRetinaClinic atUpgradeddepartmentof Ophthalmology,LLRMmedicalcollege,Meerut,India.Itwasaprospective,noncomparative,interventionalcaseseries.PatientsofocularinflammationreferredtoRetinaClinicwhounderwentsystemicevaluationwereincludedinthestudyA total of patients who satisfy the inclusion criteria , underwent systemic evaluation which include blood tests, chestradiograph,and tuberculin skin testing (0.05 _g purified protein derivative in 0.1 ml,equivalent to 2.5 tuberculin units) Botherythema and induration was measured at 48 hours,and the result were judged to be positive if induration was more than10 mmAntituberculosis therapyi.eisoniazid300mg/day,rifampin600mg/day,ethambutol 15mg/kg/day,andpyrazinamide25–30mg /kg/ day for the first 2 months ,thereafter rifampin and isoniazid were used for another 4–7 months was initiated forpatients who had clinical findings consistent with possible intraocular tuberculosis,a positive tuberculin skin test resultResponsetotherapywasassessedintermsofincreaseordecreaseorresolutionOBSERVATIONAND RESULT Ofthe total 32patients 9patients havepositive tubercular contact history and30patientsweremantouxpositive.(94%),ofwhich78%havetheirindurationsizeof>15mmand8patientshavepositivex-rayfindings.(25%)Out of these 32 patients, 25 received antituberculous therapy for 9 months. In addition all of these patients also receivedsystemicprednisone(1mg/kg/day)untilaclinicaleffectwasseenandthenaslowreductionofdosewasdone.7patientsweredroppedoutfromthestudy.Out of these 25 patients which were started on treatment, 24 patients (96%) showed improvement in their clinical status, 19patients (76%) showed improvement in their visual acuity after treatment and 35.6 % patients attained visual acuity of 6/9 orbetter.CONCLUSION Treatment with antitubercular therapy combined with systemic corticosteroids induces resolution ofinflammation with no recurrences. So, mantoux testing should remain an integral part of the systemic work-up for uveitispatients.