Long-term follow-up after treatment of tubercular uveitis: case series and review of the literature

Ikhwanuliman Putera; Paul L A van Daele; Josianne C E M Ten Berge; Willem A Dik; Rina La Distia Nora; P Martin van Hagen; Saskia M Rombach

doi:10.3389/fopht.2023.1270948

Long-term follow-up after treatment of tubercular uveitis: case series and review of the literature

Front Ophthalmol (Lausanne). 2023 Nov 17:3:1270948. doi: 10.3389/fopht.2023.1270948. eCollection 2023.

Authors

Ikhwanuliman Putera^{1

2

3

4}, Paul L A van Daele², Josianne C E M Ten Berge¹, Willem A Dik³, Rina La Distia Nora^{3

4}, P Martin van Hagen^{2

3}, Saskia M Rombach^{2

5}

Affiliations

¹ Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, Netherlands.
² Department of Internal Medicine, Section Allergy and Clinical Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.
³ Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.
⁴ Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
⁵ Department of Internal Medicine and Immunology, Rotterdam Eye Hospital, Rotterdam, Netherlands.

Abstract

Introduction: There is a scarcity of long-term follow-up data and management strategies for recurrent uveitis in tubercular uveitis (TBU), especially in cases extending beyond 10 years after the completion of initial antitubercular treatment (ATT).

Methods: This retrospective study involved five TBU patients who were initially treated with a combination of four-drug ATT for 6 months, and the five of them had more than 10 years of follow-up after uveitis resolution upon ATT completion. We describe the occurrence of recurrent uveitis and present our approach to managing these recurrent episodes.

Results: Recurrent uveitis and cystoid macular edema (CME) developed in three out of five included TBU patients with a median of 18 years (range 13-20 years) of follow-up. The anatomical sites of the recurrences were anterior, intermediate, and pan-uveitis. The recurrent episodes varied from 6 years to 15 years after ATT completion. Systemic or local corticosteroids/immunosuppressants successfully resolved all recurrent episodes, but one was also treated with the combination of isoniazid monotherapy again. Two patients needed anti-tumor necrosis factor-α therapy.

Conclusion: Long-term monitoring of TBU patients after ATT completion is warranted. Further well-designed studies with larger sample sizes are required to better estimate the risk of recurrences, investigate the underlying mechanism of recurrences, and identify biomarkers that predict who is at risk for recurrences.

Keywords: anti-tubercular treatment; follow-up; immunosuppressive; recurrence; tubercular uveitis.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. IP was supported by Indonesia Endowment Fund for Education (Lembaga Pengelola Dana Pendidikan, LPDP) (Grant No: 0004535/MED/D/19/lpdp2021). The funding source had no involvement in the collection, analysis, interpretation, or writing of the report, or the decision to submit the article for publication.