{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T20:23:39Z","timestamp":1779222219994,"version":"3.51.4"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T00:00:00Z","timestamp":1650931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Aims: Controversy exists regarding 3- or 4 drug antituberculosis therapy (conventional ATT) in uveitis patients having latent tuberculosis (LTB), especially while initiating therapy with corticosteroids and\/or other immunosuppressants. Methods: We performed a monocentral retrospective analysis of posterior uveitis patients with latent TB. Latent TB was diagnosed, in case of a positive QuantiFERON\u00ae-TB-Gold test and normal chest imaging, after ruling out other causes of infectious and noninfectious uveitis. Patients with active TB were excluded. From 2016 to 2020 we included 17 patients. Ophthalmological evaluation consisted of Best corrected visual acuity (BCVA), slit lamp examination, fundoscopy, OCT, and fluorescein- and indocyaningreen- angiography before and at months 3, 6, 12, 24, and the last follow-up after treatment. Results: Initially, all patients had active posterior uveitis with occlusive (n = 5 patients) and nonocclusive retinal vasculitis (n = 12 patients). Mean follow up was 28 \u00b1 15 months. Therapy was started with systemic corticosteroids (mean prednisolone equivalent 71.3 mg\/d) and already after 3 months it could be tapered to a mean maintenance dosage of 8.63 mg\/d. Additional immunosuppressive treatment with cs- or bDMARDs was initiated in 14 patients (82%) due to recurrences of uveitis while tapering the corticosteroids &lt;10 mg per\/day or because of severe inflammation at the initial visit. While being on immunosuppression, best corrected visual acuity increased from 0.56 logMAR to 0.32 logMAR during follow-up and only three patients had one uveitis relapse, which was followed by switch of immunosuppressive treatment. As recommended, TB prophylaxis with 300 mg\/d isoniazid was administered in 11 patients for at least 9 months while being on TNF-alpha-blocking agents. No patient developed active tuberculosis during immunosuppressive therapy. Conclusion: Mainly conventional ATT is strongly recommended\u2014as monotherapy or in combination with immunosuppressives\u2014for effective treatment in patients with uveitis due to latent TB. Although in our patient group no conventional ATT was initiated, immunosuppression alone occurred as an efficient treatment. Nevertheless, due to possible activation of TB, isoniazid prophylaxis is mandatory in latent TB patients while being on TNF-alpha blocking agents.<\/jats:p>","DOI":"10.3390\/jcm11092419","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T02:14:39Z","timestamp":1650939279000},"page":"2419","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Treatment in Latent Tuberculosis Uveitis\u2014Is Immunosuppression Effective or Is Conventional 3- or 4-Drug Antituberculosis Therapy Mandatory?"],"prefix":"10.3390","volume":"11","author":[{"given":"Eileen","family":"Bigdon","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"},{"name":"Augenzentrum Schleswig-Holstein, Peter-Ox-Stra\u00dfe 7, 25917 Leck, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nils Alexander","family":"Steinhorst","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"},{"name":"Augen\u00e4rzte Ingelheim, 55218 Ingelheim am Rhein, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Weissleder","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"},{"name":"Augen\u00e4rzte Ingelheim, 55218 Ingelheim am Rhein, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasyl","family":"Durchkiv","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"St\u00fcbiger","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1001\/archopht.123.6.844","article-title":"Ocular tuberculosis","volume":"123","author":"Thompson","year":"2005","journal-title":"Arch. Ophthalmol."},{"key":"ref_2","unstructured":"WHO (2020). Global Tuberculosis Report 2020, WHO."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.ajo.2013.11.013","article-title":"Clinical Manifestations of Patients With Intraocular Inflammation and Positive QuantiFERON\u2013TB Gold In-Tube Test in a Country Nonendemic for Tuberculosis","volume":"157","author":"Nora","year":"2014","journal-title":"Am. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.it.2016.09.007","article-title":"Tuberculosis: An infection-initiated autoimmune disease?","volume":"37","author":"Elkington","year":"2016","journal-title":"Trends Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1167\/iovs.17-23246","article-title":"Retinal Pigment Epithelial Cells Control Early Mycobacterium tuberculosis Infection via Interferon Signaling","volume":"59","author":"Nora","year":"2018","journal-title":"Investig. Opthalmol. Vis. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1183\/09031936.00115110","article-title":"Interferon-\u03b3 release assays for the diagnosis of latent Mycobacterium tuberculosis infection: A systematic review and meta-analysis","volume":"37","author":"Diel","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_7","first-page":"1","article-title":"Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection\u2014United States, 2010","volume":"59","author":"Mazurek","year":"2010","journal-title":"MMWR Recomm. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2457","DOI":"10.1177\/1120672120962066","article-title":"Uveitis associated with latent tuberculosis: A comparative study of the impact of antitubercular therapy combined or not with systemic corticosteroids","volume":"31","author":"Martel","year":"2021","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.ajo.2018.03.032","article-title":"Effect of Antituberculous Therapy on Uveitis Associated With Latent Tuberculosis","volume":"190","author":"Leong","year":"2018","journal-title":"Am. J. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/j.1442-9071.2012.02766.x","article-title":"Clinical signs of uveitis associated with latent tuberculosis","volume":"40","author":"Ang","year":"2012","journal-title":"Clin. Exp. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1136\/bjophthalmol-2011-300209","article-title":"Duration of anti-tubercular therapy in uveitis associated with latent tuberculosis: A case-control study","volume":"96","author":"Ang","year":"2012","journal-title":"Br. J. Ophthalmol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.ajo.2008.06.011","article-title":"Role of anti-tubercular therapy in uveitis with latent\/manifest tuberculosis","volume":"146","author":"Bansal","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/j.ophtha.2009.02.005","article-title":"Diagnosis of tuberculous uveitis: Clinical application of an interferon-gamma release assay","volume":"116","author":"Ang","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.ajo.2008.06.021","article-title":"Interferon-gamma release assays in the diagnosis of tuberculous uveitis","volume":"146","author":"Albini","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_15","first-page":"509","article-title":"Standardization of Uveitis Nomenclature (SUN) Working Group","volume":"140","author":"Jabs","year":"2005","journal-title":"Am. J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1038\/eye.2008.115","article-title":"Initial results of QuantiFERON-TB Gold testing in patients with uveitis","volume":"23","author":"Itty","year":"2009","journal-title":"Eye"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"6473","DOI":"10.1038\/s41598-017-06899-1","article-title":"Active Tuberculosis Incidence and Characteristics in Patients Treated with Tumor Necrosis FactorAntagonists According to Latent Tuberculosis Infection","volume":"7","author":"Lee","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1167\/iovs.05-0981","article-title":"Visual acuities \u201chand motion\u201d and \u201ccounting fingers\u201d can be quantified with the freiburg visual acuity test","volume":"47","author":"Feltgen","year":"2006","journal-title":"Investig. Opthalmology Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v075.i06","article-title":"robustlmm: An R package for robust estimation of linear mixed-effects","volume":"75","author":"Koller","year":"2016","journal-title":"J. Stat. Softw."},{"key":"ref_20","unstructured":"R Core Team (2016). R: A Languuage and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1164\/rccm.200206-626OC","article-title":"Incidence of serious side effects from first-line antituberculosis drugs among patients treated for active tuberculosis","volume":"167","author":"Yee","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.autrev.2015.01.011","article-title":"Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice","volume":"14","author":"Cantini","year":"2015","journal-title":"Autoimmun. Rev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1183\/13993003.01245-2015","article-title":"Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries","volume":"46","author":"Getahun","year":"2015","journal-title":"Eur. Respir. J."},{"key":"ref_24","first-page":"144","article-title":"Incidence and risk factors of major toxicity associated to first-line antituberculosis drugs for latent and active tuberculosis during a period of 10 years","volume":"21","author":"Castro","year":"2015","journal-title":"Rev. Port. Pneumol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"447","DOI":"10.5588\/ijtld.11.0766","article-title":"Incidence of ethambutol-related visual impairment during treatment of active tuberculosis","volume":"17","author":"Ezer","year":"2013","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/0970-2113.148428","article-title":"A prospective study of ocular toxicity in patients receiving ethambutol as a part of directly observed treatment strategy therapy","volume":"32","author":"Garg","year":"2015","journal-title":"Lung India"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/01.tp.0000269104.22502.d2","article-title":"Isoniazid-related hepatic failure in children: A survey of liver transplantation centers","volume":"84","author":"Wu","year":"2007","journal-title":"Transplantation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1164\/rccm.200502-196OC","article-title":"Routine hospital use of a new commercial whole blood interferon-gamma assay for the diagnosis of tuberculosis infection","volume":"172","author":"Ferrara","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Colangeli, R., Arcus, V.L., Cursons, R.T., Ruthe, A., Karalus, N., Coley, K., Manning, S.D., Kim, S., Marchiano, E., and Alland, D. (2014). Whole genome sequencing of Mycobacterium tuberculosis reveals slow growth and low mutation rates during latent infections in humans. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0091024"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1056\/NEJMoa1714283","article-title":"Four Months of Rifampin or Nine Months of Isoniazid for Latent Tuberculosis in Adults","volume":"379","author":"Menzies","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_31","first-page":"CD000171","article-title":"Treatment of latent tuberculosis infection in HIV infected persons","volume":"2010","author":"Akolo","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1378\/chest.128.1.116","article-title":"Isoniazid hepatotoxicity associated with treatment of latent tuberculosis infection: A 7-year evaluation from a public health tuberculosis clinic","volume":"128","author":"Fountain","year":"2005","journal-title":"Chest"},{"key":"ref_33","first-page":"CD001363","article-title":"Isoniazid for preventing tuberculosis in non-HIV infected persons","volume":"1999","author":"Smieja","year":"1999","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2419\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:01:03Z","timestamp":1760137263000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2419"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,26]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["jcm11092419"],"URL":"https:\/\/doi.org\/10.3390\/jcm11092419","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,26]]}}}