Background The number of patients we are treating for ophthalmic tuberculosis (TB) have increased year on year, from two in 2009 to twenty in 2013. A recent global review of the strategies used in the diagnosis and treatment of ophthalmic TB showed a wide disparity of diagnostic and treatment strategies. We present a review of our current practice and justification for out treatment regimens.
Methods We identified all the cases in our hospital treated for ophthalmic TB between 2009 and 2013. Age, gender, ophthalmic examination findings, blood tests, treatment regimens, including durations and outcomes, and adverse drug reactions were collected and analysed.
Results A total of 60 cases were identified. Mean age was 45.0 +/- 14.4 years. 61.7% were male. The most commonly used regimen was 2 months rifampicin, isoniazid, pyrazinamide and moxifloxacin followed by 10 months of rifampicin, isoniazid and moxifloxacin. A response to treatment, with no evidence of disease recurrence on cessation of therapy, was seen in 78.3% of cases. 5% experienced hepatotoxicity requiring a change in treatment. There was no significant difference in either the success of treatment (p = 0.102) or the risk of hepatotoxicity (p = 0.264) between regimens with moxifloxacin (n = 43) or without it (n = 17). 32 patients on moxifloxacin had ECGs of which 6 (18.8%) newly developed a raised QTc. This resulted in moxifloxacin being stopped during the step-down phase of treatment in two patients. Maximum QTc was never found to be above 500 milliseconds and there were no episodes of documented arrhythmias or syncope.
Conclusions We recommend a treatment regimen including moxifloxacin in place of ethambutol so that any reported visual change is unlikely to be related to treatment, and we propose continuing moxifloxacin beyond the intensive phase, if tolerated, when culture is unavailable. We treat ophthalmic TB for the same duration as central nervous system TB. Our data shows that this is a safe and effective regimen but more evidence is required before recommending definitive guidelines.