Management of presumed intraocular tuberculosis: possible role of the polymerase chain reaction

Purpose: A highly selective technique of polymerase chain reaction (PCR) wa s performed for detection of Mycobacterium tuberculosis from aqueous sample s of 45 patients to evaluate its role in initiating antituberculosis treatm ent in patients with presumed intraocular tuberculosis. Methods: Forty-five patients were divided into three groups. Group I includ ed 17 patients of presumed intraocular tuberculosis, group II 13 disease co ntrols and group III had 15 normal controls, Patients with positive PCR wer e offered antituberculosis chemotherapy and followed up for a minimum of 18 months. Results: Ten patients in group I, 3 in group II and none in group III were positive for Mycobacterium tuberculosis by PCR, Ten patients with positive PCR for Mycobacterium tuberculosis (8 in group I and 2 in group II) were tr eated with antituberculosis chemotherapy and all showed resolution of infla mmation without any recurrence over 18 months of follow-up, Two PCR positiv e patients treated with steroids alone, however, did not show complete reso lution and had recurrent attacks. Conclusion: These results suggest that antituberculosis treatment in PCR po sitive patients leads to resolution of inflammation and elimination of recu rrences, most likely by eliminating Mycobacterium tuberculosis from the int raocular tissues.