Professional Documents
Culture Documents
UKRIDA
Manifestation of TB-Eye
Phlyctenulosis
unilateral - typically affects children photophobia, lacrimation blepharospasm delayed hypersensitivity to tuberculin protein topical steroids /steroidab
Intraocular Tuberculosis
Intraocular tuberculosis represents an extrapulmonary
form of the disease and they are seen in more than 50% of the patients who have both AIDS and tuberculosis
Jones et al: showed that the risk of extrapulmonary TB
4. Retinitis and retinal vasculitis 5. Neuroretinitis and optic neuropathy 6. Endophthalmitis and panophthalmitis Eales disease is considered by some to reflect tuberculous infection or hypersensitivity
can be divided into four groups: 1.Choroidal tubercles 2.Choroidal tuberculoma 3.Subretinal abscess 4.Serpiginous-like choroiditis
Choroidal Tubercles
Right eye of a 24-yearold woman with tubercular meningitis showing optic disk edema, multiple small choroidal tubercles, and a healed choroidal tuberculoma temporal to the fovea with retinochoroidal anastamosis.
Choroidal Tuberculoma
(A) There are two granulomas in the upper temporal and lower nasal quadrant in the right eye In view of a strongly positive Mantoux test ( >20 mm induration) and positive chest x-ray, patient was given ATT with concomitant oral corticosteoids.
Endophthalmitis - Panophthalmitis
Acute onset and shows rapid progression with
hypopyon, filling the anterior chamber with purulent material and involving the cornea
In panophthalmitis, the sclera is also involved, which
Panophthalmitis ec TB . OD
UTZ
Diagnosis
Clinical indicators
Corroborative evidence
(Purified Protein Derivative, Chest Radiography and Computerized Tomography, Serodiagnosis or ELISA) Direct evidence (Acid-Fast, Culture of Intraocular Fluid/Tissue, Polymerase Chain Reaction)
Diagnosis
QuantiFERON is an approved, antigen specific test
QuantiFERON
Blood samples are mixed with antigens
The advantages:
> Is not subject to reader bias that can occur with Mantoux test > Is not affected by prior BCG (bacille CalmetteGurin) vaccination A positive result suggests that M. tuberculosis infection is likely; a negative result suggests that infection is unlikely
Diagnosis
Level I
Identification M.Tb in Ocular fluid/tissue
Level II
Level III
Suggestive pattern of intraocular inflammation +
Treatment
MEDICAL MANAGEMENT 1. Drug Regimens for Treating Intraocular Tuberculosissimilar to those for pulmonary or extrapulmonary tuberculosis Comanagement with pulmonologist/internist
2. Duration of Treatment The initial regimen: RHZE. Pyrazinamide and ethambutol were stopped after 2 to 3 months and treatment with isoniazid and rifampin was continued for 9 to 12 months
5. Ocular Side Effects of Anti-Tubercular Drugs The ethambutol toxicity is rare if the daily dose does not exceed 15mg/kg. Of the patients receiving daily dose of 25 mg/kg or more, 1--2% experience ocular toxicity
HIV-AIDS
Selected Anterior segment manifestation:
Molluscum contagiosum
HZO
Herpes simplex
HIV Retinopathy
Ocular micro-angiopathic syndrome Non-infectious microvascular disorder characterised
by cotton wool spots, microaneurysms, retinal haemorrhages, Roth spots, telangiectatic vascular changes and areas of capillary non-perfusion
HIV Retinopathy
Cotton-wool spots (CWS) are the most common ocular micro-angiopathic manifestations of HIV/AIDS
CMV-Retinitis
CMV retinitis was a frequent opportunistic infection among patients with AIDS typically occurred in patients with CD4 T cells (helper T cells) 50 cells/L
CMV-Retinitis
Cytomegalovirus retinitis has been reported to affect up to 25% to 40% of HIV patients and is the most common cause of visual loss
Highly active antiretroviral therapy (HAART) effectively suppresses HIV replication, resulting in immune recovery, which, if sufficient, controls retinitis without anti-CMV therapy.
CMV-Retinitis Treatment
The induction regimen consisted of injection of 2
mg/0.04 ml of ganciclovir twice weekly for 4 weeks followed by a similar dose weekly for 4 weeks and then a weekly maintenance regimen of 1.0 mg/0.02 ml ganciclovir anti-CMV drugs are virostatic, and treatment has to be given in a continuous to prevent recurrence of the disease.
TOXOPLASMOSIS
This is a case of a 20 y.o F with blurring of vision 1 week
ptc. Associated with eye soreness, mild eye redness, seeing floaters and half of visual defect. Pt likes to consume street food satae No fever nor cough. (-) history of allergic Had prior consult but gain no relief
Ophthalmological Status
OD
VA : 2/60 (inferior side) Mild ciliary injection Clear cornea -f/-c +2 vitreous cell IOP 59 mmHg VA : 1.0 No injection Clear cornea -f/-c - vitreous cell IOP 12 mmHg
OS
Full EOM
+/+RC (-)RAPD
Full EOM
+/+RC (-)RAPD
Ancillary Test
Ro Thorax PA : Mild Infiltrate on left parahiler Aorta Calsification Ass: Bronchopneumonia DD/ Pulmonary TB
Hematologi
Hb 13.9 g/dl L 9.2 0/1/2/76/21/0 Ht 43 Tromb 285.000 Blood sugar 126mg/dl
Immunologi
Ig G Toxoplasma
OD with secondary glaucoma Meds: Ab-steroid topical 6x OD Timolol 0.5% 2x OD Cotrimoksazol forte 2x 1 tab Acetazolamide 250mg 3x 1 tab Methylprednisolone 1 x 48mg pc Kalium oral 2x1 tab
BCVA S-1.00 c -0.50 x 160 --- 0.8 (-) ciliary injection (-) vit cell IOP 10 mmHg () OS : VAD sc 1.0 IOP 12 mmHg
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