Tuberculous uveitis: association between anti-tuberculous therapy and clinical response in a non-endemic country

BACKGROUND The study aims to report the association between successful uveitis control following anti-tuberculous therapy (ATT) for uveitis associated with a positive tuberculosis (TB) screening test in a low endemic setting. A retrospective chart review of cases between 2010 and 2017 at a tertiary uveitis referral center in the United States of America was conducted. Subjects with any form of uveitis, a positive TB interferon-gamma release assay or tuberculin skin test, and negative evaluation for other causes of uveitis were included. ATT was recommended in all cases and completed therapy was categorized as either adequate or inadequate for active TB infection. Location and severity of inflammation and the use of local versus systemic corticosteroid therapy was assessed at presentation and again after recommendation of ATT. RESULTS Thirty-one eyes of 20 individuals were identified. Uveitis activity improved in 22 eyes of 15 patients (13 treated adequately for active TB, 2 not adequately treated). Nine eyes of 5 patients did not have improved activity (1 adequately treated, 4 not adequately treated). All 9 individuals presenting with posterior or panuveitis who improved were adequately treated whereas the remaining 2 who did not improve were not (P 0.02). Among those with anterior or intermediate uveitis, no clear treatment patterns were observed between those who did and did not improve (P 0.50). Six individuals (30%) experienced significant ATT-related adverse effects. CONCLUSIONS In a non-endemic setting, ATT for uveitis associated with a positive TB screening test may provide benefit in controlling ocular inflammation, particularly for those with posterior or panuveitis. The role for ATT in anterior or intermediate uveitis is less clear.