Revisiting Tuberculosis in Uveitis: Immunopathogenesis and the Role of Antitubercular Therapy

Rina La Distia NoraIndonesia Speaker Revisiting Tuberculosis in Uveitis: Immunopathogenesis and the Role of Antitubercular Therapy.Tuberculosis-associated uveitis (TB-uveitis) remains a major cause of intraocular inflammation in TBendemic countries. Its immunopathogenesis involves both direct ocular infection by Mycobacterium tuberculosis and immune-mediated responses to mycobacterial antigens. The overlapping clinical features and absence of systemic TB in many cases make diagnosis and treatment particularly challenging. This presentation revisits the current understanding of TB-uveitis, focusing on the immune mechanisms involved and their clinical implications. We discuss how latent TB infection may act as a trigger for ocular inflammation and explore the limitations of existing diagnostic criteria. To address the uncertainty surrounding treatment decisions, we conducted a randomized controlled trial in Indonesia involving patients with uveitis of undetermined cause who tested positive for QuantiFERONTB Gold Plus. All participants received immunosuppressive therapy, with half receiving additional antitubercular therapy (ATT). At six months, the ATT group had significantly higher rates of complete uveitis resolution and fewer relapses during extended follow-up. We also conducted a translational study evaluating peripheral blood expression of interferon-inducible genes. A higher baseline gene expression score was associated with favorable treatment outcomes, suggesting a potential role for immune biomarkers in guiding therapy. This talk integrates clinical and translational findings to offer a more personalized and evidence-based approach to managing TB-uveitis. The goal is to move beyond empirical ATT toward tailored treatment strategies informed by immunologic profiles and regional disease patterns.