Abstract:  Objective  To summarize the clinical features of paradoxical reactions in tuberculous uveitis. Design Retrospective case series. Participants  8 tuberculous uveitis patients (10 eyes) with paradoxical reactions after initial anti-tuberculosis treatment in Beijing Tongren Hospital from 2012 to 2020. Methods All the patients’  medical records were reviewed. Mean follow-up time was (10.0±5.6) months. Main Outcome Measures  Anterior segment and  fundus manifestation, treatment situation. Results The average age of 8 patients with paradoxical reactions was (45.0±10.8）years. One patient (12.5%) had active pulmonary tuberculosis, 6 patients (75.0%) had suspected previous pulmonary tuberculosis infection,  and one patient (12.5%) had no clear history of tuberculosis. Paradoxical reactions occurred 0.5 to 1.5 months (average 0.9±0.3 months) after the initial anti-tuberculosis treatment. Among the 10 eyes with tuberculous uveitis, 2 eyes (20.0%) had choroidal tuberculoma, and the paradoxical reaction was manifested as tumor enlargement and superficial retinal detachment; 3 eyes (30.0%) had pan uveitis, manifested as aggravated inflammatory reaction of anterior chamber and vitreous body, and increased macular edema; 2 eyes (20.0%) had intermediate uveitis, manifested as aggravated vitreous opacity; 3 eyes (30.0%) had serpiginous choroiditis, which showed increased yellow-white lesions and increased areas of high autofluorescence in the fundus. All patients received regular antituberculosis drugs and systemic or local glucocorticoids after the occurrence of paradoxical reactions, and the inflammatory reactions were effectively controlled. Conclusion The paradoxical reactions in patients with tuberculous uveitis mostly occurred within 1 month after initial anti-tuberculosis treatment for tuberculosis latent infection or previous infection. The combined application of standardized anti-tuberculosis drugs and anti-inflammatory drugs could significantly reduce the paradoxical reactions. (Ophthalmol CHN, 2022, 31: 277-281)

Key words: tuberculous uveitis, antituberculosis treatment, paradoxical reaction