Elsevier

Ophthalmology

Volume 118, Issue 4, April 2011, Pages 772-777
Ophthalmology

Original article
Ocular Tuberculosis: A Clinicopathologic and Molecular Study

https://doi.org/10.1016/j.ophtha.2010.08.011Get rights and content

Objective

To analyze the clinical profiles, histopathologic features, and Mycobacterium tuberculosis polymerase chain reaction testing in patients with ocular tuberculosis.

Design

Retrospective case series.

Participants

Forty-two patients.

Methods

This retrospective study was approved by the Armed Forces Institute of Pathology (AFIP) Institutional Review Board. The AFIP data banks were screened for cases with diagnosis of ocular tuberculosis using key words such as mycobacterium; tuberculosis; and acid-fast bacilli. Files and slides stained with hematoxylin–eosin and acid-fast staining were reviewed by the Division of Ocular Pathology and by the Infectious Diseases and Parasitic Diseases Pathology Branches. When available; blocks and unstained slides were sent to the Doheny Eye Institute; Los Angeles; California; for quantitative polymerase chain reaction (qPCR) analysis to detect Mycobacterium tuberculosis-specific DNA.

Main Outcome Measures

Tuberculin skin test (TST) results, as well as the chest radiograph results, were recorded. When acid-fast bacilli were identified in tissue, their locations—ocular or extraocular sites—were recorded. Emphasis was placed on lymph node involvement and any systemic diseases.

Results

In the histopathologic specimens, microscopy revealed a paucity of organisms, and often there were only 1 or 2 organisms associated with or near a giant cell or near an area of necrosis. The qPCR analysis was performed on 6 biopsy specimens. These specimens showed necrotizing granulomatous inflammation from 6 different patients; 3 had positive qPCR results. In 2 of the 3 cases with positive qPCR results, acid-fast bacilli were not found in the tissue sections. In 17 patients, TST results were available; 10 had positive results (60%) and 7 had negative results (40%). Fourteen chest radiograph results were submitted, and 8 (57%) of 14 patients had normal chest films.

Conclusions

This study suggests that in dealing with those populations at increased risk of tuberculosis (e.g., immigrants from endemic areas and human immunodeficiency virus-infected patients) or patients receiving biologic therapy, the ophthalmologist should endeavor to entertain this diagnosis and to rely on the support of infectious disease specialists and pulmonologists to help solidify the diagnosis, because the current methods for the diagnosis have limited sensitivity.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

This retrospective study was approved by the AFIP Institutional Review Board. The AFIP data banks were screened for cases with the diagnosis of ocular tuberculosis using key words such as mycobacterium; tuberculosis; and acid-fast bacilli. Files and slides stained with hematoxylin–eosin and acid-fast staining were reviewed by the Division of Ocular Pathology and by the Infectious Diseases and Parasitic Diseases Pathology Branches. When available; blocks and unstained slides were sent to the

Results

The dates of the cases ranged from 1932 to 2007 and the age of the patients ranged from 1 to 76 years. Table 1 (available at http://aaojournal.org) reports the pediatric cases and Table 2 (available at http://aaojournal.org) reports the adult cases. When provided, the duration of disease was from several weeks to more than 40 years. Forty-two biopsy specimens or enucleated globes were reviewed from 42 patients; in 37 patients, the ocular or ocular adnexal structures revealed the presence of

Discussion

This study was completed by analyzing the data banks and repository at the AFIP in Washington, DC, during a more than 75-year interval and offers unique contributions to our understanding of ocular tuberculosis. Although the study suffers foremost from selection bias as a tertiary ocular pathology referral center and is dependent on the history provided by the referring physicians, it offers an ample number of cases with unique clinicopathologic correlations supported by demonstration of the

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    Manuscript no. 2010-97.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Drs Wroblewski and Zapor are officers in the United States Army and the opinions expressed herein are solely theirs and not the Departments of the Army or Defense.

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