Neues zur Therapie der okulären Tuberkulose

BACKGROUND: Tuberculous uveitis (TU) is initially usually not acute, accompanied by only slight visual disorders and affects otherwise healthy individuals so that the diagnosis is frequently primarily overlooked. OBJECTIVE: This study was carried out to provide an update of the treatment options in suspected TU. MATERIAL AND METHODS: A PubMed search was undertaken using the key terms uveitis AND tuberculosis AND treatment for manuscripts published within the last decade. Cross-identified articles relevant to the topic were also evaluated regarding their evidence based on the authors' expertise. RESULTS: When the suspicion of a TU is not supported by further investigations, the decision has to weigh up the risks and benefits of treatment. A response of the uveitis to antituberculous treatment (ATT) in 82% represents an important diagnostic indication. Based on this remarkably good response rate and an acceptable side effect profile of ATT, a generous indication seems reasonable. A lack of response or a paradox worsening of uveitis under treatment for manifestations of extrapulmonary tuberculosis, probably represent a hypersensitivity reaction to mycobacterial antigens and require additional corticosteroid treatment. Eales' disease, an isolated retinal vasculitis, is associated with TU but does not respond to ATT and requires laser ablation of the ischemic area. CONCLUSION: TU typically affects otherwise healthy individuals without extraocular manifestations. Early consideration of TU and initiation of ATT ideally before the start of systemic corticosteroids is decisive for long-term functional recovery. Treatment success, defined as absence of new uveitic flares within 6 months of treatment cessation, is to be expected in at least 82%. In cases of paradox worsening or lack of response, additional anti-inflammatory treatment is required.