Essentials in Ophthalmology

Transcription

1 Essentials in Ophthalmology Series Editor Arun D. Singh More information about this series at

2 Atul Kumar Rohan Chawla Namrata Sharma Editors Ocular Tuberculosis

3 Editors Atul Kumar, MD, FAMS Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Rohan Chawla, MD, FRCS(Glasg) Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India Namrata Sharma, MD, DNB Dr. Rajendra Prasad Centre for Ophthalmic Sciences All India Institute of Medical Sciences New Delhi, India ISSN Essentials in Ophthalmology ISBN DOI / ISSN X (electronic) ISBN (ebook) Library of Congress Control Number: Springer International Publishing AG 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

4 Preface Tuberculosis (TB) has protean disease manifestations. Most cases of tuberculosis are caused by Mycobacterium tuberculosis. Other organisms causing tuberculosis include M. bovis, M. africanum and M. microti, all of which together are grouped as M. tuberculosis complex. Mycobacteria are slow- growing, aerobic, acid-fast bacilli. Pulmonary tuberculosis is the most common manifestation of tuberculosis with airborne droplets being the most common mode of person-to-person transmission. An active case of TB is the most common source. About 15 20% of all cases of TB in immunocompetent patients are extrapulmonary TB (EPTB), whereas EPTB accounts for 50% of all cases of TB in immunocompromised patients. The most common site of extrapulmonary TB is lymph nodes, followed by pleural effusion. The host response and thus manifestation of the disease depend on host immune status and whether the infection is the primary exposure of the organism to the host immunity or a secondary response to an already sensitized host. The prevalence of tuberculosis is very high in most developing and underdeveloped nations. Thus clinicians in tuberculosis-endemic regions always consider ruling out tuberculosis as a differential for a plethora of disease manifestations. Such is also the case with ocular disease, and thus tuberculosis has been implicated as an aetiological agent for many ocular disorders. The difficulty in obtaining adequate ocular tissue for histopathological and microbiological analysis makes it difficult to prove or disprove the role of tuberculosis in many such ocular disorders. However, indirect evidence, presence of concomitant systemic disease, response to anti-tubercular therapy and new evidence based on modern molecular microbiological assays have enhanced our understanding of the association of tuberculosis with ocular disease. Though we do have some definite answers, yet, the aetiology of many ocular diseases is still labelled as probable tuberculosis. The issue gets further complicated when we try to relate an ocular disease manifestation to active tubercular infection vis-a-vis an immunological response. In this text we discuss some of the controversies and provide the reader with a comprehensive update on the work done on many facets of ocular tuberculosis. New Delhi, India Atul Kumar, MD, FAMS Rohan Chawla, MD, FRCS(Glasg) Namrata Sharma, MD, DNB v

5 Contents 1 Epidemiological Aspect of Ocular Tuberculosis... 1 May Zun Aung Win and Soon-Phaik Chee 2 Pathogenesis and Pathology of Ocular Tuberculosis... 7 Seema Sen 3 Imaging Studies for Ocular Tuberculosis Atul Kumar, Rohan Chawla, and Ruchir Tewari 4 Laboratory and Radiological Investigations in the Diagnosis of Ocular Tuberculosis Randeep Guleria and Vijay Noel Nongpiur 5 Tuberculin Skin Test and Interferon-γ Release Assays in the Diagnosis of Ocular Tuberculosis Nicole Shu-Wen Chan and Soon-Phaik Chee 6 Management of Ocular Tuberculosis Nitin Kumar, Eliza Anthony, Parthopratim Dutta Majumder, Ranju Kharel (Sitaula), and Jyotirmay Biswas 7 Tubercular Uveitis Atul Kumar, Rohan Chawla, Raghav Ravani, and Koushik Tripathy 8 Tubercular Multifocal Serpiginoid Choroiditis Sahil Jain, Aniruddha Agarwal, Kanika Aggarwal, and Vishali Gupta 9 Tubercular Retinitis and Retinal Vasculitis Soumyava Basu and Taraprasad Das 10 Tuberculous Optic Neuropathy Rohit Saxena and Divya Singh 11 Ocular Tuberculosis in Immunocompromised Patients Pukhraj Rishi, Ekta Rishi, Sridevi Nair, S. Sudharshan, and Sharanya Abraham 12 Conjunctival and Corneal Tuberculosis Namrata Sharma and Neelima Aron vii

6 viii Contents 13 Tubercular Scleritis Mi Fang Helen, Rupesh Agrawal, Vishali Gupta, and Carlos Pavesio 14 Orbital and Periorbital Tuberculosis Neelam Pushker and Amar Pujari Index

7 Contributors Sharanya Abraham, MBBS, DO, DNB Uvea Department, Sankara Nethralaya, Chennai, TN, India Aniruddha Agarwal, MS Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India Kanika Aggarwal, MS Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India Rupesh Agrawal, FRCS, MD National Healthcare Group Eye Institute, Moorfields Eye Hospital, NHS Foundation Trust, Tan Tock Seng Hospital, Singapore, Singapore Eliza Anthony, MBBS, DNB Ophthalmology Uvea Services, Medical Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India Neelima Aron, MD Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Soumyava Basu, MS L V Prasad Eye Institute, Bhuabneswar, India Jyotirmay Biswas, MBBS, MS, FMRF, FAICO Uveitis & Ocular Pathology Department, Medical Research Foundation, Sankara Nethralaya, Chennai, India Nicole Shu-Wen Chan, MBBS Singapore National Eye Centre, Singapore Rohan Chawla, MD, FRCS(Glasg) Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Soon-Phaik Chee, FRCS(Ed), FRCS(G) Singapore National Eye Centre, Singapore Singapore Eye Research Institute, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Duke-NUS Graduate Medical School Singapore, Singapore Taraprasad Das, MD L V Prasad Eye Institute, Hyderabad, India ix

8 x Contributors Randeep Guleria, MD, DM Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India Vishali Gupta, MS Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India Mi Fang Helen, MBBS National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore Sahil Jain, MS Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India Atul Kumar, MD, FAMS Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Nitin Kumar, MBBS, MS Uvea Services, Medical Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India Parthopratim Dutta Majumder, MBBS, MS, FMRF Uvea Services, Medical Research Foundation Sankara Nethralaya, Chennai, Tamil Nadu, India Sridevi Nair, MD Sankara Nethralaya, Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, TN, India Vijay Noel Nongpiur, MD Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India Carlos Pavesio, MD, FRCOphth Moorfields Eye Hospital, London, UK Amar Pujari, MD Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Neelam Pushker, MD Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Raghav Ravani, MBBS, MD Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Science, New Delhi, India Ekta Rishi, MS Sankara Nethralaya, Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, TN, India Pukhraj Rishi, MS, FRCS Sankara Nethralaya, Shri Bhagwan Mahavir Vitreoretinal Services, Chennai, TN, India Rohit Saxena, MD, PhD Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Department of Ophthalmology, New Delhi, India Seema Sen, MD, Pathology Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Department of Ocular Pathology, New Delhi, India Namrata Sharma, MD, DNB Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

9 Contributors xi Divya Singh, MBBS, MD, DNB Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Department of Ophthalmology, New Delhi, India Ranju Kharel (Sitaula), MD, FAICO Department of Ophthalmology, Maharajgunj Medical Campus, B. P. Koirala Lions Centre for Ophthalmic Studies, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal S. Sudharshan, MS Uvea Department, Sankara Nethralaya, Chennai, TN, India Ruchir Tewari, MD, FICO Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Koushik Tripathy, MD, FRCS (GLASG) Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India May Zun Aung Win, MB, BS, MMedSc(Ophth) Ocular Inflammation and Immunology Department, Singapore National Eye Centre, Singapore, Singapore