1. India
Prof. Dr. Jyotirmay Biswas MS. FMRF, FNAMS, FIC Path., FAICO
Director of Uveitis and Ocular Pathology department
Sankara Nethralaya,
18, College Road, Nungambakkam
Chennai – , India.

3. Top 5 things in Tubercular uveitis

4. 1

5. When do you suspect tubercular uveitis ?
Granulomatous anterior or intermediate uveitis
Broad posterior synechiae
Retinal vasculitis with choroiditis
Multifocal serpiginoid choroiditis
Sub-retinal abscess
Choroidal nodule

8. Am J Ophthalmol 2010;149: 562-570 Broad –based posterior synechiae
Retinal vasculitis with or without choroiditis
Serpiginous like choroiditis

9. When do you suspect tubercular uveitis ?
It can have protean manifestations

12. 17 yr old girl biopsy proven abdominal TBOD
Frosted branch angiitis due to Tuberculosis

13. Pre treatment
Post treatment with ATT

14. 2

15. Tubercular Uveitis- what are the tests ?
Mantoux and QuantiFERON TB gold test is supportive only
Exposure does not mean active infection
Do anterior chamber tap, vitreous aspiration, FNAB
Subject to polymerase chain reaction for MTB genome

16. 40% positive cases were Mantoux negative
Ophthalmology 2011;118:
40% positive cases were Mantoux negative

17. QuantiFERON TB gold test alone may not be specific for intraocular TB.
Ind J Ophthalmol 2009,57 (6)
QuantiFERON TB gold test alone may not be specific for intraocular TB.
The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB

18. 3

19. Tubercular Uveitis X ray Chest is not enough
Do high resolution CT chest

20. Ocular Immunology and Inflammation, 19(1),51-57,2011
81% TB, 8.3% sarcoidosis

21. Chest HRCT showing tree in bud appearance
Subretinal abscess.
Chest HRCT showing tree in bud appearance

22. 4

23. Intraocular Fluid study often gives the diagnosis
Polymerase chain reaction is often diagnostic
Sensitivity around 80%
Specificity 100%

24. 21 year old female with gran
21 year old female with gran. Anterior uveitis with mutton fat KPs and broad post and peripheral anterior synechiae
AC tap
done

25. Agarose gel electrophoretogram representing the results of
Mycobacterium tuberculosis PCR targeting MP64 gene and IS6110 region
200 bp
MPB IS6110
MPB64 gene IS6110
NC2 : Negative control second round NC2 : Negative control second round
NC1 : Negative control first round NC1 : Negative control first round
VRF 4948/12 AC tap : Positive VRF 4948/12 AC tap : Positive
PC : Positive Control H37RV DNA PC : Positive Control H37RV DNA
100 bp : Molecular weight marker 100 bp ladder

26. FNAB specimen PCR for MTB +
SUBRETINAL ABSCESS
FNAB
Blood
Before treatment
FNAB specimen PCR for MTB +

27. 5

28. How do you treat tubercular uveitis?
Start with four drug anititubercular therapy
Always combine with steroid

29. Tubercular Uveitis- what is the duration of treatment ?
Don’t treat as pulmonary TB for 6months
Treat as extra pulmonary TB and give ATT at least for 9 months

30. British Journal Of Ophthalmology November 2012
What is the correct duration of anti tubercular therapy?
British Journal Of Ophthalmology November 2012

31. A SANKARA NETHRALAYA PRESENTATION
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A SANKARA NETHRALAYA PRESENTATION