TB endophthalmitis was diagnosed in 18/44 (40.9%) of cases and TB panophthalmitis was seen in 25/44 (56.8%) of cases. One case reported the final diagnosis as "ocular tuberculosis". Ocular outcomes were generally poor with 36/43 cases (83.7%) requiring enucleation, evisceration or exenteration. Pre-phthisis or phthisis bulbi was reported in 3 cases (7.0%), final visual acuity 20/200 and worse was seen in 3 cases (7.0%) and a single case reported visual acuity better than 20/200 (2.3%). Only two authors reported a favorable visual outcome. In the case reported by Hase et al, visual acuity improved from light perception at presentation to 20/200 at 13 months' follow-up. The patient was treated with prompt PPV soon after presentation and was started on corticosteroids and ATT before culture results, based on the miliary lung disease discovered on CT scan. In the report by Yaghoubi et al, a 45-year-old man with concomitant TB pericarditis underwent a prompt tap-and-inject of vancomycin and amikacin. Oral corticosteroids were started early given the concomitant cardiac disease. Quadruple ATT could not be maintained for the total duration of treatment but isoniazid and ethambutol were given for 18 months. The visual acuity improvement from 20/630 to 20/32 was maintained for up to 3 years.
Table 8 summarizes the best reported method of diagnosis and microbiologic findings. A TB etiology was confirmed on histopathologic specimen (HPS) after removal of the eye in 32/44 cases (72.7%). The earliest source of TB confirmation came from the vitreous (PPV or tap) in 6/44 cases (13.6%) and via an AC tap in 3/44 cases (6.8%). The studies reported a variety of microbiologic studies including microscopy to look for acid-fast bacilli (AFB) and LGCs. Mycobacterial cultures, PCR and genomic deletion analysis were also used. Microscopy revealed AFB in 33/43 cases (76.7%) and LGCs only in 7/43 cases (16.3%). Mycobacterial cultures from vitreous, anterior chamber or HPS were reported in 18/43 cases (41.9%) and were positive in 14/18 cases (77.8%). PCR was reported in 12/43 cases (27.9%) and was positive in all cases. Detailed case-by-case descriptions are available in Table 3. The most specific reported microbiologic finding was M. tuberculosis in 19/44 cases (43.2%), AFB in 17/44 cases (38.6%), LGCs in 6/44 cases (13.6%) and M. bovis in 1/44 case (2.3%). One case from 2006 reported "TB etiology" as their final microbiologic finding.