Ocular Manifestations among Newly Diagnosed Tuberculosis Patients Receiving Anti-Tubercular Therapy under Revised National Tuberculosis Control Programme: A Prospective Cohort Study

Abstract

Introduction: Ocular tuberculosis has diverse presentations. As microbiological confirmation is difficult, a high index of suspicion is required. The present study replenishes the gap of existing knowledge regarding ocular tuberculosis and facts related to antitubercular drug related toxicity. Aim: To evaluate the magnitude and outcome of ocular tuberculosis along with antitubercular drug related ocular toxicity, with special reference to ethambutol toxicity. Materials and Methods: This cohort study was conducted from May 2018 to April 2019 at Outpatient Department of Ophthalmology, Burdwan Medical College and Hospital, West Bengal, India. Total 170 newly diagnosed tuberculosis patients underwent comprehensive ophthalmic examination for any signs of ocular tuberculosis or development of antitubercular drug related ocular toxicity. They were treated and followed up to the completion of Anti-Tubercular Therapy (ATT). The statistical software Statistical Package for the Social Sciences (SPSS) version 20.0 was used for the analysis. Results: Out of total 170 study participants, 110 (64.7%) were male, mean age was 35.65±15.49 years. Ocular tuberculosis was found in 12 (7.05%) patients. Four patients had choroidal tuberculoma, two had Eales disease, four had choroiditis, two had anterior and intermediate uveitis. All the ocular tubercular lesions responded to ATT. Total 7 (4.1%) patients developed ethambutol-induced ocular toxicity. Following stoppage of ethambutol and treatment with corticosteroids there was significant improvement in colour vision, perimetry and Visual Evoked Potential (VEP) findings in 3 (42.9%) patients. Unfortunately, 4 (57.1%) patients developed optic atrophy. Conclusion: Comprehensive ophthalmic examination should to be done in all tuberculosis patients to detect and treat co-existing ocular tuberculosis as well as early detection of antitubercular drug toxicity. Withholding of the offender can result in visual recovery

Keywords

• choroidal tuberculoma
• ethambutol toxicity
• eales disease
• ocular tuberculosis
• uveitis