T

BEST OF BEST PAPERS OF ALL SESSIONS 33

This paper was conferred with the NARSING A RAO Award for the BEST PAPER of UVEA Session.
AUTHORSS PROFILE:
DR. JYOTIRMAY BISWAS: M.S., PGIMER, Chandigarh; Fello, !R
S"rger#, San$ara %e&hrala#a, Chennai; Fello, O'h&hal(i) Pa&holog#, *ohen#
E#e In+&i&"&e, So"&hern Cali,ornia, USA. Pre+en&l# *ire)&or, *e'&. o,
U-ei&i+ and Head, *e'&. o, O'h&hal(i) Pa&holog#, San$ara %e&hrala#a, Chennai.
BEST PAPER
OF
UVEA
SESSION
Clinical Profile of Tubercular Uveiti in A Tertiar! Care
O"#t#al$ic Centre
*r. .#o&ir(a# /i+a+, *r. Ren" A&hani$ar, *r. S"dhar+han. S., Mi++. 0alee(anni+ha
1Pre+en&ing A"&hor: *r. Ren" A&hani$ar2
"3er)"lo+i+ i+ a )o(("ni)a3le di+ea+e
)a"+ed 3# M#)o3a)&eri"( &"3er)"lo+i+ or rela&ed
(e(3er+ o, &he T/ )o('le4. A3o"& 567 o, in,e)&ed
indi-id"al+ 3e)o(e +#('&o(a&i) o, hi)h 5897
're+en& a+ "-ei&i+. :67 re(ain in,e)&ed ,or &he
re+& o, &heir li-e+ i&ho"& (ani,e+&ing &he
di+ea+e.
9
Tho"gh o)"lar &"3er)"lo+i+ i+ rare,
in)iden)e o, '"l(onar# and e4&ra'"l(onar# T/
ha+ in)rea+ed 8 in 'ar& 3e)a"+e o, &he ra'id
+'read o, AI*S.
;
O)"lar T/ i+ de,ined a+ an
in,e)&ion 3# M. &"3er)"lo+i+ in &he e#e, aro"nd
&he e#e, or on i&+ +"r,a)e.
9
Cla++i)all# i& ha+ 3een di-ided in&o &o &#'e+
3a+ed on i&+ 'a&hogene+i+: 'ri(ar# and +e)ondar#.
Pri(ar# di+ea+e i('lie+ &ha& &he e#e i+ &he ini&ial
'or& o, en&r# hile in +e)ondar# di+ea+e &he
organi+(+ +'read &o &he e#e he(a&ogeno"+l#.
Pri(ar# di+ea+e in)l"de+ )on<"n)&i-al, )orneal, and
+)leral di+ea+e, hile &"3er)"lo"+ "-ei&i+ i+ a )o((on
(ani,e+&a&ion o, +e)ondar# di+ea+e.
=
The T/ 3a)ill"+
i+ highl# aero3i), i&h an a,,ini&# ,or o4#gena&ed
&i++"e+. Th"+, &"3er)"lo+i+ ,re>"en&l# a,,e)&+ a'i)e+
o, l"ng+ a+ ell a+ &he )horoid+, hi)h ha+ &he
highe+& 3lood ,lo ra&e in &he 3od#. The (o+&
)o((on )lini)al ,inding+ o, in&rao)"lar T/ in)l"de
+oli&ar# or ("l&i'le )horoidal nod"le+, )horoidi&i+
and re&inal -a+)"li&i+.
?,@856
The )horoidal nod"le+
+"gge+& dire)& he(a&ogeno"+ in,e)&ion hile
-a+)"li&i+ and )horoidi&i+ are (ore li$el# &o 3e re+"l&
o, i(("ne h#'er+en+i&i-i&#. T"3er)"lo"+ an&erior
"-ei&i+ i+ &#'i)all# gran"lo(a&o"+ and a))o('an#ing
-i&ri&i+ i+ no& "n)o((on.
9
T/ +ho"ld 3e )on+idered
in di,,eren&ial diagno+i+ o, )hroni)
an&erior gran"lo(a&o"+ "-ei&i+ i&h or i&ho"&
'o+&erior +eg(en& in-ol-e(en&. A3+en)e o, )lini)all#
e-iden& '"l(onar# T/ doe+ no& r"le o"& &he 'o++i3ili&#
o, o)"lar T/, a+ A67 o, 'a&ien&+ i&h e4&ra
'"l(onar# T/ ha-e no e-iden)e o, '"l(onar#
&"3er)"lo+i+.
A
To anal#+e &he )lini)al 'ro,ile, &rea&(en& and -i+"al
o"&)o(e in 'a&ien&+ i&h e-iden)e o, +#+&e(i)
&"3er)"lo+i+ and "-ei&i+ +"+'e)&ed a+ &"3er)"lar
"-ei&i+ 're+en&ing i&h -aried o)"lar (ani,e+&a&ion+ in
a &er&iar# e#e )are )en&re 3e&een .an"ar# 966B and
*e)e(3er 966B.
Material an% Met#o%
Thi+ a+ a re&ro+'e)&i-e, non8)o('ara&i-e,
in&er-en&ional &#'e +&"d#. =? e#e+ o, 9B 'a&ien&+ ere
anal#+ed. The 'a&ien&+ ere 're+"(ed &o ha-e
&"3er)"lo"+ "-ei&i+ i, &he# ,"l,illed one o, &he
,olloing )ri&eria:
5. "-ei&i+ i&h 'rior do)"(en&ed hi+&or# o, +#+&e(i)
&"3er)"lo+i+.
9. "-ei&i+ i&h )orro3ora&i-e e-iden)e o, +#+&e(i)
di+ea+e i&h 'o+i&i-e Man&o"4 +$in &e+& and )he+&
radiogra'h.
;. PCR anal#+i+ ,or M. &"3er)"lo+i+ ,ro(
a>"eo"+ or -i&reo"+ +a('le.
=. Po+i&i-e C"an&i,eron gold &e+& ,or M.
&"3er)"lo+i+.
?. F%AC ,ro( hilar or )er-i)al l#('hnode 'o+i&i-e
,or )#&olog#.
A de&ailed hi+&or# a+ eli)i&ed and a )o('le&e o)"lar
e4a(ina&ion a+ )ond")&ed ,or all 'a&ien&+. The
,olloing de(ogra'hi) and
34 AIOC 2009 PROCEEDINGS
(edi)al da&a a+ re)orded : 'a&ien& age, gender,
(edi)al hi+&or#, la&erali&# o, di+ea+e, ini&ial -i+"al
a)"i&#, o)"lar ,inding+ li$e an&erior +eg(en& ,lare,
)ell+, $era&i) 're)i'i&a&e+, +#nae)hiae, a++o)ia&ed
-i&ri&i+ i, 're+en&, (or'hologi) de+)ri'&ion o,
)horoidal le+ion+ and addi&ional ,ea&"re+ i, an#.
Che+& D8ra# and Man&o"4 &e+& ere done in all
'a&ien&+. USG / +)an +hoing )horoidal (a++ a+
done in 5A e#e+. A>"eo"+ &a' a+ done in @ e#e+.
!i&reo"+ &a' a+ done in = e#e+. F%AC a+ done in 5
'a&ien&. C"an&i,eron gold &e+& a+ done in 5 'a&ien&.
All 'a&ien&+ ere &rea&ed i&h an&i &"3er)"lo"+
&rea&(en& and +&eroid+ 1&o'i)alE'erio)"larE+#+&e(i)2.
Pa&ien&+ ere ,olloed "' reg"larl# "'&o a 'eriod o,
5 #ear and &rea&(en& re+'on+e a+ a++e++ed 3a+ed on
-i+"al a)"i&# and +&a&"+ o, an&erior and 'o+&erior
+eg(en& in,la((a&ion.
Reult
=? e#e+ o, 9B 'a&ien&+ ere anal#+ed. Age range a+ B
&o A9 #ear+, (ean age o, 're+en&a&ion 3eing
3# %agini Sar-anan&han e& al.
59
/"& o"r +&"d#
re-ealed )horoidal gran"lo(a a+ &he )o((one+&
're+en&a&ion. Sa(+on MC
5
e& al re'or&ed &ha&
&"3er)"lar an&erior "-ei&i+ i+ &#'i)all# gran"lo(a&o"+
and (a# o))"r i&h or i&ho"& 'o+&erior +eg(en&
in-ol-e(en& hi)h )oin)ide+ i&h o"r +&"d#.
T"3er)"lo"+ "-ei&i+ ha+ -aried 're+en&a&ion+ +")h a+
)horoidal gran"lo(a, in&er(edia&e "-ei&i+,
gran"lo(a&o"+ an&erior "-ei&i+, 'an"-ei&i+, ("l&i,o)al
)horoidi&i+ and +er'igino"+ li$e )horoidi&i+ a+ +een in
o"r +&"d#. Th"+ a high inde4 o, +"+'i)ion +ho"ld 3e
're+en& &o 'i)$ "' T/ "-ei&i+ and 'ro('& &rea&(en&
i&h an&i &"3er)"lo"+ dr"g+ +ho"ld 3e +&ar&ed. G"'&a
e& al
5;
re'or&ed a +erie+ o, +e-en )a+e+ i&h
+er'igino"+ li$e )horoidi&i+. All +e-en )a+e+ had
,"nd"+ ,ea&"re+ +"gge+&i-e o, &hi+ )ondi&ion 3"&
)on&in"ed &o 'rogre++ in +'i&e o, ade>"a&e +&eroid
&rea&(en& and +"3+e>"en&l# re+'onded &o ATT. O"r
+&"d# +hoed 5 +")h 're+en&a&ion.
The diagno+i+ o, &"3er)"lo+i+ i+ ,re>"en&l#
;9.; #ear+. Pre+en&a&ion a+ 3ila&eral in 5@
're+"('&i-e.
9
*e,ini&i-e diagno+i+ i+ 3#
1AA.AA72 'a&ien&+ and "nila&eral in : 1;;.;;72
'a&ien&+. : 1;;.;;72 'a&ien&+ had 'rior do)"(en&ed
hi+&or# o, +#+&e(i) &"3er)"lo+i+ hile 5@ 1AA.AB72
'a&ien&+ had no 're-io"+ hi+&or# o, &"3er)"lo+i+.
Clini)al 're+en&a&ion+ in)l"ded: )horoidal gran"lo(a
in 99 e#e+ 1=@.@@
72, in&er(edia&e "-ei&i+ in : e#e+ 19672,
gran"lo(a&o"+ an&erior "-ei&i+ in A e#e+ 15;.;;72,
'an"-ei&i+ in ; e#e+ 1A.B72, ("l&i,o)al )horoidi&i+ in
= e#e+ 1@.:72 and +er'igino"+ li$e )horoidi&i+ in 5
e#e 19.972. Che+& D8ra# and Man&o"4 &e+& ere
done in all 'a&ien&+ hile 'ol#(era+e )hain
rea)&ion 1PCR2 on a>"eo"+E-i&reo"+ +a('le+, ,ine
needle a+'ira&ion )#&olog# 1F%AC2, C"an&i,eron gold
&e+& ere done in +ele)&ed 'a&ien&+. Mo+& )o((on
(odali&# o, &rea&(en& a+ a )o(3ina&ion o, an&i
&"3er)"lo+i+ &rea&(en& 1ATT2 and +&eroid+
1&o'i)alE'erio)"larEoral2. !i+ion i('ro-ed in A6
7 in e#e+, re(ained +&a3le in 5;.;;7 e#e+ and
de&eriora&ed in 9A.AA 7 e#e+.
Dicuion
O)"lar &"3er)"lo+i+ 're+en&+ a )o('le4 )lini)al
'ro3le( d"e &o a ide +'e)&r"( o, 're+en&a&ion+ and
di,,i)"l&# in diagno+i+.
?,A,B
U-ei&i+ i+ &he (o+& )o((on
o)"lar (ani,e+&a&ion and )an 're+en& a+ an&erior,
'o+&erior, or 'an"-ei&i+
5
o, hi)h &he (o+& )o((on
i+ )horoidi&i+ a+ +hon in a +&"d#
de(on+&ra&ion o, &"3er)le 3a)illi in &i++"e
o3&ained 3# 3io'+#. In o"r +&"d# F%AC a+ done
in 5 'a&ien& hi)h ga-e 'o+i&i-e re+"l&. /"& o)"lar
(ani,e+&a&ion+ (a# re+"l& ,ro( a dela#ed
h#'er+en+i&i-i&# rea)&ion in a3+en)e o, an# in,e)&io"+
agen&.
B
Th"+ e-al"a&ing 're+en)e o, +#+&e(i)
di+ea+e i+ o, 'ri(e i('or&an)e. Man&o"4 +$in &e+& i+
&he +&andard &e+& ,or diagno+i+ o, +#+&e(i) T/.
B
A
'o+i&i-e +$in &e+& i+ de&e)&a3le ; &o @ ee$+ a,&er
'ri(ar# in,e)&ion. An in&en+e +$in rea)&ion i+ an
i(("nologi) re+'on+e 3a+ed on dela#ed
h#'er+en+i&i-i&#. There i+ no +'e)i,i) +iFe o,
ind"ra&ion &ha& )on,ir(+ T/, nor doe+ a nega&i-e
&e+& e4)l"de diagno+i+ o, T/.
B
Th"+ &he re+"l&+ o,
Man&o"4 &e+& need &o 3e in&er're&ed $ee'ing in (ind
're-io"+ /CG -a))ina&ion, e4'o+"re &o
non&"3er)"lo"+ (#)o3a)&eria and +#+&e(i)
i(("no+"''re++ion or (aln"&ri&ion. In )a+e+ o,
diagno+&i) dile((a PCR ,or o)"lar ,l"id )an 3e done.
I& i+ a ra'id &e+& i&h a high +en+i&i-i&# and +'e)i,i)i&#.
=
I& i+ (ore "+e,"l 3e)a"+e onl# a +(all +a('le i+
needed and -ia3le )ell+ are no& re>"ired.
=
In o"r +&"d#
PCR &e+&ing o, a>"eo"+ a+ done in @ e#e+ o, hi)h =
+hoed 'o+i&i-e re+"l&. PCR &e+&ing o, -i&reo"+
+a('le a+ done in = e#e+ o, hi)h 9 +hoed
'o+i&i-e re+"l&. %eer &e+&+ +")h a+ C"an&i,eron T/
gold &e+& are 3a+ed on ga((a in&er,eron 'rod")&ion
3# T )ell+ +en+i&iFed &o +'e)i,i)
BEST OF BEST PAPERS OF ALL SESSIONS 35
an&igen+, hi)h are +'e)i,i) &o M. &"3er)"lo+i+ and
&here,ore no& in,l"en)ed 3# /CG or (o+&
non&"3er)"lo"+ 3a)&eria. In o"r +&"d# 5 'a&ien& a+
+"3<e)&ed &o &hi+ &e+& &o )on,ir( diagno+i+ o, T/.
Re+'on+e &o &rea&(en& i+ (ainl# (oni&ored 3#
3a)&eriologi)al e-al"a&ion. Pa&ien&+ i&h '"l(onar#
T/ +ho"ld ge& &heir +'"&"( e4a(ina&ion done
(on&hl# &ill )"l&"re+ &"rn nega&i-e. In )a+e o, o)"lar
T/ &he re+'on+e &o &rea&(en& ("+& 3e a++e++ed
)lini)all#. Re+'on+e "+"all# o))"r+ i&hin ,ir+& 9
ee$+. Pa&ien&+ on ATT +ho"ld al+o 3e ed")a&ed and
(oni&ored ,or dr"g &o4i)i&#. LFT +ho"ld 3e done
reg"larl# and (edi)ine+ +ho"ld 3e di+)on&in"ed i,
&here are +ign+ o, dr"g ind")ed he'a&i&i+. O'&i)
ne"ri&i+ (a# o))"r i&h e&ha(3"&ol and eigh&h
ner-e da(age (a# o))"r i&h +&re'&o(#)in.
H#'er+en+i&i-i&# rea)&ion+ (a# al+o o))"r and (a#
need di+)on&in"a&ion o, &hera'#. A)"&e
"-ei&i+ ha+ 3een re'or&ed i&h ri,a('in.
55
5. T"3er)"lar "-ei&i+ ha+ 'ro&ean
(ani,e+&a&ion+.
9. A high inde4 o, +"+'i)ion hel'+ in earl# diagno+i+
o, T/ "-ei&i+.
;. Man&o"4 &e+& re(ain+ a +&andard &e+& &o diagno+e
o)"lar &"3er)"lo+i+.
=. In )a+e o, diagno+&i) dile((a, PCR &e+&ing o,
in&rao)"lar ,l"id )an hel' in diagno+i+.
?. %eer &e+&+ li$e >"an&i,eron )an 3e -er#
+"''or&i-e and ha-e in)rea+ed &he diagno+&i)
#ield.
A. ATT in addi&ion &o &o'i)alE'erio)"larE +#+&e(i)
+&eroid+ re(ain+ a+ a (ain+&a# o, &rea&(en&.
B. I('ro-e(en& o, o)"lar )ondi&ion i+ 3a+ed on earl#
re)ogni&ion and a''ro'ria&e (anage(en& o,
+#+&e(i) )ondi&ion.
Reference
5. Sa(+on MC, Fo+&er CS. T"3er)"lo+i+. In:
Fo+&er CS, !i&ale AT 1ed+2. *iagno+i+ and
&rea&(en& o, U-ei&i+. G/ Sa"nder+ Co('an#:
Philadelphia, 9669; ' 9A=8B9.
9. !ar(a *, Anand S, Redd# AR, *a+ A,
Ga&+on .P, C"rrie *C, S"&)li,,e I, /a)$ho"+e
OC. T"3er)"lo+i+ : an "nder8diagno+ed
ae&iologi)al agen& in "-ei&i+ i&h an e,,e)&i-e
&rea&(en&. Eye. 966A;96:56A@8B;.
;. Pan"-ei&i+: in A(eri)an A)ade(# o,
O'h&hal(olog#: Se)&ion :8In&rao)"lar
in,la((a&ion and "-ei&i+ 966?8966A;5:;.
=. She" S., Sh#" .S, Chen LM, Chen HH, Chirn SC,
Gang .S. O)"lar (ani,e+&a&ion+ o, &"3er)"lo+i+.
Ophthalmology 9665;56@:5?@68?.
?. /i+a+ ., Madha-an H%, Go'al L, /adrina&h SS.
In&rao)"lar &"3er)"lo+i+. Clini)o'a&ho8 logi)
+&"d# o, ,i-e )a+e+. Retina 5::?;5?:=A58@
Re-ie.
A. Al-areF S, M)Ca3e GR. E4&ra'"l(onar#
&"3er)"lo+i+ re-i+i&ed: A review of experience at
Boston City and other hospitals. (Baltimore)
5:@=;A;:9?8??.
B. /odaghi /, LeHoang P. O)"lar &"3er)"lo+i+
1re-ie2 Crr Opin Ophthalmol 9666;55:==;8@.
@. Ro+en P H,S'al&on *., Graha( E
M.In&rao)"lar &"3er)"lo+i+. Eye 5::6:=:=@A8:9.
:. I+hihara M,Ohno S 1O)"lar &"3er)"lo+i+2.
!ippon Rinsho 5::@:?A:;5?B8A5.
56. Cange(i FE,Fried(an A H,.o+e'h3erg
R.T"3er)"lo(a o, &he )horoid+ Ophthalomology
5:@6;@B:9?98@.
55. S'indler E, *e'l"+ S, Flage"l /.U-ei&e+ aig"e+ a"
)o"r+ de+ rea)&ion+ de re-er+ion. Acta "eprol
5::5;B:;;58=.
59. %agini S, Mar&in G, 0i( /:in&rao)"lar
&"3er)"lo+i+ i&ho"& de&e)&a3le +#+&e(i)
in,e)&ion: Arch Ophthalmol 5::@:55A;5;@A8@.
5;. !i+hali G"'&a, A(od G"'&a, S"nil A,
Pradee' /, Manga& *, Ani&a A. Pre+"(ed
&"3er)"lar +er'igino"+ li$e )horoidi&i+:
Ophthalmology 966;;556:5B==8:.