Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 1

Agrawal, Rupesh; Testi, Ilaria; Mahajan, Sarakshi; Yuen, Yew Sen; Agarwal, Aniruddha; Kon, Onn Min; Barisani-Asenbauer, Talin; Kempen, John H.; Ak, Gupta; Jabs, Douglas A.; Smith, Justine R.; Nguyen, Quan Dong; Pavésio, Carlos; Gupta, Vishali; Agarwal, Mamta; Agarwal, Manisha; Aggarwal, Ashutosh N.; Aggarwal, Kanika; Agrawal, Mukesh; Al-Dhibi, Hassan; Androudi, Sofia; Asyari, Fatma; Balasundaram, Manohar Babu; Murthy, Kalpana Babu; Baglivo, Edoardo; Banker, Alay; Bansal, Reema; Basu, Soumyava; Behera, Digamber; Biswas, Jyotirmay; Bodaghi, Bahram; Carreño, Ester; Caspers, Laure; Chee, Soon Phaik; Chhabra, Romi; Cimino, Luca; Río, Luz Elena Concha del; Cunningham, Emmett T.; Curi, André Luiz Land; Das, Dipankar; Davis, Janet; Desmet, Marc; Денисова, Е. В.; Denniston, Alastair K.O.; Errera, Marie‐Hélène; Fonollosa, Alejandro; George, Amala Elizabeth; Goldstein, Debra A.; Crosier, Yan Guex; Gunasekeran, Dinesh Visva; Gurbaxani, Avinash; Invernizzi, Alessandro; Isa, Hazlita Mohd; Islam, Shah Md.; Jones, Nicholas P.; Katoch, Deeksha; Khairallah, Moncef; Khosla, Amit; Kramer, Michal; Kumar, Amitabh; Kumar, Atul; Nora, Rina La Distia; Lee, Richard; Lowder, Careen Y.; Luthra, Saurabh; Mahendradas, Padmamalini; Makhoul, Dorine; Mazumdar, Shahana; McCluskey, Peter; Mehta, Salil; Miserocchi, Elisabetta; Mochizuki, Manabu; Mohamed, Oli S.; Muccioli, Cristina; Munk, Marion R.; Murthy, Somasheila; Narain, Shishir; Nascimento, Heloísa; Neri, Piergiorgio; Nguyen, Myhanh; Okada, Annabelle A.; Özdal, Pınar; Palestine, Alan G.; Pichi, Francesco; Raje, Dhananjay; Rathinam, Sivakumar R.; Rousselot, Andrés; Schlaen, Ariel; Sehgal, S; Sen, H. Nida; Sharma, Aman; Sharma, Kusum; Shoughy, Samir S.; Singh, Nirbhai; Singh, Ramandeep; Soheilian, Masoud; Sridharan, Sridha; Thorne, Jennifer E.; Tappeiner, Christoph; Teoh, Stephen; Tognon, M.S.; Tuğal-Tutkun, İlknur; Tyagi, Mudit; Uy, Harvey S.; Santos, Daniel Vítor Vasconcelos; Valentinčič, Nataša Vidović; Westcott, Mark; Yanai, Ryoji; Alvarez, Bety Yañez; Rahman, Zahedur; Zierhut, Manfred

doi:10.1016/j.ophtha.2020.01.008

Cited by 62 publications

(55 citation statements)

References 41 publications

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“…The process used to achieve consensus around the management of childhood JIA‐type uveitis followed the Delphi method, 15 which has been used effectively to develop consensus around other forms of uveitis, including the Standardization of Uveitis Nomenclature—Nomenclature for Reporting Clinical Data, 7 and classification criteria for 25 uveitis subtypes 29 — Criteria of the International Workshop on Ocular Sarcoidosis for the diagnosis of sarcoidosis, 30 and the Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis 31 . The Delphi process seeks to give a broad voice: the questionnaire allowed all interested uveitis specialists (29 of the 46 members of the RANZCO Uveitis SIG) to express an opinion.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Smith

Matthews

Conrad

et al. 2021

Clinical Exper Ophthalmology

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Importance Australian‐ and New Zealand‐based, uveitis‐specialized ophthalmologists have produced recommendations for the management of juvenile idiopathic arthritis (JIA)‐type chronic anterior uveitis. Background Historically, the visual prognosis of JIA‐type chronic anterior uveitis has been poor. New medical advances are likely to improve outcomes, but recently published guidelines are tailored for ophthalmic care in Europe and the United States. Design This work involved a consensus survey and a panel meeting. Participants The Australian and New Zealand JIA‐Uveitis Working Group (29 ophthalmologists) participated in the work. Methods The Delphi technique was used to achieve consensus. Main Outcome Measures This work yielded consensus statements. Results The Working Group achieved consensus around 18 statements related to clinical evaluation, use of topical and regional corticosteroids, use of systemic corticosteroid and non‐corticosteroid immunomodulatory drugs, and management of secondary cataract and glaucoma in childhood JIA‐type uveitis. Conclusions and Relevance Recommendations of the Australian and New Zealand JIA‐Uveitis Working Group provide current and regionally applicable advice for managing chronic anterior uveitis in children with JIA.

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Section: Discussionmentioning

confidence: 99%

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Smith

Matthews

Conrad

et al. 2021

Clinical Exper Ophthalmology

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“…To address the uncertainty in the management of OTB and bridge the gap between clinical need and medical evidence, the COTS group, in collaboration with IUSG, IOIS, and FOIS, has recently developed consensus guidelines for the initiation of ATT for specific clinical phenotypes and proposed guidelines for concomitant adjunctive therapy in patients with TBC. [ 71 ] From the study it emerged that specific sub-phenotypes of TBC influence the therapeutic decision of starting ATT, as well as TB endemicity in the geographical region of patient's origin. In TB SLC, given the strong association of the sub-phenotype with MTB, even one positive immunologic evidence, namely a positive PPD skin test or IGRA, not supported by radiologic findings, is considered enough to start ATT.…”

Section: When To Treat?mentioning

confidence: 99%

“…Systemic corticosteroids could be initiated concomitantly with or soon after the administration of ATT in patients with TB SLC, tuberculoma with no active systemic infection, and TB MC/TB FC, unless there is a high risk of significant ocular complications due to severe inflammatory reaction. [ 71 ] When the inflammation recurs during tapering, systemic corticosteroid-sparing immunosuppressants can be started in patients with TB SLC and TB MC/TB FC.…”

Section: When To Treat?mentioning

confidence: 99%

Ocular tuberculosis: Where are we today?

Testi

Agrawal

Mehta

et al. 2020

Indian J Ophthalmol

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Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.

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“…10e14 The first report from the COTS Consensus Group outlined 70 consensus statements addressing the initiation of ATT in the 3 different subtypes of tubercular choroiditis: serpiginous-like choroiditis, tuberculoma, and multifocal or unifocal choroiditis. 15 Although the first report of the COTS Consensus Group addressed some of the distinctive phenotypes of TBU, entities such as anterior uveitis, intermediate uveitis, panuveitis, and retinal vasculitis are more challenging when it comes to initiating ATT. 15 Moreover, analysis of the COTS 1 showed significantly higher hazard ratios of treatment failure associated with phenotypes of intermediate uveitis, anterior uveitis, and panuveitis compared with tubercular choroiditis.…”

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confidence: 99%

“…15 Although the first report of the COTS Consensus Group addressed some of the distinctive phenotypes of TBU, entities such as anterior uveitis, intermediate uveitis, panuveitis, and retinal vasculitis are more challenging when it comes to initiating ATT. 15 Moreover, analysis of the COTS 1 showed significantly higher hazard ratios of treatment failure associated with phenotypes of intermediate uveitis, anterior uveitis, and panuveitis compared with tubercular choroiditis. 1 Ophthalmologists may make decisions to initiate ATT based on purified protein derivative (PPD) skin test results, interferon-g release assay (IGRA) results, or both, but these tests may have limitations related to their sensitivity and specificity.…”

mentioning

confidence: 99%

Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 2

Agrawal¹,

Testi

Bodaghi

et al. 2021

Ophthalmology

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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. Ophthalmology 2021;128:277-287 ª 2020 by the American Academy of Ophthalmology Supplemental material available at www.aaojournal.org. See Commentary on page 288. Diagnosis and management of tubercular uveitis (TBU) pose a significant challenge because of the lack of specific diagnostic criteria and disagreement among uveitis specialists on the initiation of antitubercular therapy (ATT). 1e5 The Collaborative Ocular Tuberculosis Study (COTS) was designed to address the knowledge gaps related to the diagnosis and management of TBU. 1,6e9 The COTS 1 was a retrospective study that highlighted geographic variations in the management practices and regional differences in treatment outcomes, and thus the need for global uniform 277

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Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 1

Cited by 62 publications

References 41 publications

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Recommendations for the management of childhood juvenile idiopathic arthritis‐type chronic anterior uveitis

Ocular tuberculosis: Where are we today?

Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 2

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