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Fundus findings in a series of patients with extrapulmonary tuberculosis in Thailand
  1. Choeng Jirawison1,
  2. Yingna Liu2,3,
  3. Karjbundid Surasit4,
  4. Ernest Maningding3,
  5. Siripim Kamphaengkham4,
  6. Somsanguan Ausayakhun5,
  7. David Heiden6,
  8. Todd P Margolis7,
  9. John A Gonzales3,8,
  10. Nisha R Acharya3,8,
  11. Jeremy David Keenan3,8
  1. 1 Department of Ophthalmology, Nakornping Hospital, Chiang Mai, Thailand
  2. 2 Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Francis I Proctor Foundation, University of California San Francisco, San Francisco, California, USA
  4. 4 Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand
  5. 5 Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  6. 6 Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California, USA
  7. 7 Department of Ophthalmology, Washington University, St Louis, Missouri, USA
  8. 8 Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Jeremy David Keenan, F.I. Proctor Foundation, University of California, San Francisco, 513 Parnassus Avenue, Box 0412, San Francisco 94143-0412, California, USA; jeremy.keenan{at}


Aim The aim of this study was to determine the frequency of fundus abnormalities among patients who are undergoing or have recently completed treatment for extrapulmonary tuberculosis (eTB).

Methods This is a prospective cross-sectional study conducted in a TB clinic of a tertiary hospital in northern Thailand. All patients who had eTB between January 2014 and August 2015 were invited by telephone to return to the clinic for fundus photography. Three uveitis specialists reviewed all photographs to identify posterior segment lesions that were consistent with ocular TB.

Results A total of 265 patients were diagnosed with eTB during the specified period, of which 118 (44.5%) were reached by telephone and 60 (50.8%) participated in the study. A total of 7 eyes from six patients (10.0% of participants, 95% CI 2.2% to 17.8%) had lesions consistent with ocular TB. The group with possible ocular TB lesions was on average 16.8 years older than those without ocular lesions (p=0.01), but the two groups were otherwise not significantly different.

Conclusion Ocular lesions consistent with TB were not rare in a group of patients who were undergoing or had recently completed treatment for eTB. Fundus examination may provide diagnostic information that could influence a clinician’s beliefs when diagnosing eTB. Given the low costs and immediate results of eye examination, this diagnostic test should be considered in patients suspected for eTB, especially when other tests are negative.

  • Ocular tuberculosis
  • Mycobacterium tuberculosis

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  • Contributors CJ, YL, KS, SA, DH, TPM, JDK: Substantial contributions to the conception or design of the work.

    YL, EM, SK, JG, NA, JDK: Acquisition, analysis or interpretation of data.

    YL, DH, TPM, JG, JDK: Drafting of the manuscript or revising it critically for important intellectual content.

    YL, DH, JDK: Final approval of the version published.

    JDK: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was supported by the JaMel Perkins Family Foundation, the Fortisure Foundation, That Man May See, the Littlefield Trust, the Peierls Foundation and Research to Prevent Blindness. YL is a Doris Duke International Clinical Research Fellow. She received a grant from the Doris Duke Charitable Foundation (New York, New York) through the Doris Duke International Clinical Research Fellows Program at the University of California, San Francisco. The funders have no role in the design and conduct of the study.

  • Competing interests None declared.

  • Patient consent No identifiable or direct patient information is released in this manuscript to require a BMJ patient consent form.

  • Patient consent Not commissioned; externally peer reviewed.

  • Ethics approval This prospective cross-sectional study was conducted with approval from the Committee on Human Research at the University of California, San Francisco and the Institutional Review Board of Nakornping Hospital, Chiang Mai, Thailand.