Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 2: Guidelines for Initiating Antitubercular Therapy in Anterior Uveitis, Intermediate Uveitis, Panuveitis, and Retinal Vasculitis

Rupesh Agrawal, Ilaria Testi, Baharam Bodaghi, Talin Barisani-Asenbauer, Peter McCluskey, Aniruddha Agarwal, John H. Kempen, Amod Gupta, Justine R. Smith, Marc D. de Smet, Yew Sen Yuen, Sarakshi Mahajan, Onn Min Kon, Quan Dong Nguyen, Carlos Pavesio, Vishali Gupta, Collaborative Ocular Tuberculosis Study Consensus Group, Rupesh Agrawal, Ilaria Testi, B BodaghiTalin Barisani-Asenbauer, Peter McCluskey, Aniruddha Agarwal, John Kempen, Amod Gupta, Justine Smith, Yew Sen Yuen, Sarakshi Mahajan, Mamta Agarwal, Manisha Agarwal, Ashutosh Aggarwal, Kanika Aggarwal, Mukesh Agrawal, Hassan Al-Dhibi, Sofia Androudi, Fatma Asyari, Manohar Babu Balasundaram, Kalpana Babu Murthy, Edoardo Baglivo, Alay Banker, Reema Bansal, Soumyava Basu, Digamber Behera, Jyotirmay Biswas, Ester Carreño, Laure Caspers, Soon Phaik Chee, Romi Chhabra, Luca Cimino, Luz Elena Concha del Rio, Emmett T. Cunningham, Andrè Luiz Land Curi, Dipankar Das, Janet Davis, Marc DeSmet, Ekaterina Denisova, Alastair K. Denniston, Marie Hélène Errera, Alejandro Fonollosa, Amala George, Debra A. Goldstein, Yan Guex Crosier, Dinesh Visva Gunasekeran, Avinash Gurbaxani, Alessandro Invernizzi, Hazlita M. Isa, Shah M.d. Islam, Nicholas Jones, Deeksha Katoch, Moncef Khairallah, Amit Khosla, Michal Kramer, Amitabh Kumar, Atul Kumar, Rina La Distia Nora, Richard Lee, Careen Lowder, Saurabh Luthra, Padmamalini Mahendradas, Dorine Makhoul, Shahana Mazumdar, Salil Mehta, Elisabetta Miserocchi, Manabu Mochizuki, Oli S. Mohamed, Cristina Muccioli, Marion R. Munk, Somasheila Murthy, Shishir Narain, Heloisa Nascimento, Piergiorgio Neri, Myhanh Nguyen, Annabelle A. Okada, Pinar Ozdal, Alan Palestine, Francesco Pichi, Dhananjay Raje, S. R. Rathinam, Andres Rousselot, Ariel Schlaen, Shobha Sehgal, H. Nida Sen, Aman Sharma, Kusum Sharma, Samir S. Shoughy, Nirbhai Singh, Ramandeep Singh, Masoud Soheilian, Sudharshan Sridharan, Jennifer E. Thorne, Christoph Tappeiner, Stephen Teoh, Maria Sofia Tognon, Ilknur Tugal-Tutkun, Mudit Tyagi, Harvey Uy, Daniel Vitor Vasconcelos Santos, Natasa Vidovic Valentincic, Mark Westcott, Ryoji Yanai, Bety Yanez Alvarez, Rahman Zahedur, Manfred Zierhut, Zheng Xian, Onn Min Kon, Quan Dong Nguyen, Carlos Pavesio, Vishali Gupta

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Abstract

Topic: The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular Immunological Society, set up an international, expert-led consensus project to develop evidence- and experience-based guidelines for the management of tubercular uveitis (TBU). Clinical Relevance: The absence of international agreement on the use of antitubercular therapy (ATT) in patients with TBU contributes to a significant heterogeneity in the approach to the management of this condition. Methods: Consensus statements for the initiation of ATT in TBU were generated using a 2-step modified Delphi technique. In Delphi step 1, a smart web-based survey based on background evidence from published literature was prepared to collect the opinion of 81 international experts on the use of ATT in different clinical scenarios. The survey included 324 questions related to tubercular anterior uveitis (TAU), tubercular intermediate uveitis (TIU), tubercular panuveitis (TPU), and tubercular retinal vasculitis (TRV) administered by the experts, after which the COTS group met in November 2019 for a systematic and critical discussion of the statements in accordance with the second round of the modified Delphi process. Results: Forty-four consensus statements on the initiation of ATT in TAU, TIU, TPU, and TRV were obtained, based on ocular phenotypes suggestive of TBU and corroborative evidence of tuberculosis, provided by several combinations of immunologic and radiologic test results. Experts agreed on initiating ATT in recurrent TAU, TIU, TPU, and active TRV depending on the TB endemicity. In the presence of positive results for any 1 of the immunologic tests along with radiologic features suggestive of past evidence of tuberculosis infection. In patients with a first episode of TAU, consensus to initiate ATT was reached only if both immunologic and radiologic test results were positive. Discussion: The COTS consensus guidelines were generated based on the evidence from published literature, specialists’ opinions, and logic construction to address the initiation of ATT in TBU. The guidelines also should inform public policy by adding specific types of TBU to the list of conditions that should be treated as tuberculosis.

Original languageEnglish
Number of pages11
JournalOphthalmology
Early online date27 Jun 2020
DOIs
Publication statusE-pub ahead of print - 27 Jun 2020

Keywords

  • Collaborative Ocular Tuberculosis Study Consensus (COTS CON)
  • Tubercular Uveitis
  • Antitubercular Therapy
  • anterior uveitis
  • panuveitis
  • retinal vasculitis

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