Effect of Antituberculous Therapy on Uveitis Associated With Latent Tuberculosis

Tomkins-Netzer, Oren; Leong, Belinda C.S.; Zhang, Xiaozhe; Lightman, Sue; McCluskey, Peter; Lee, A.J.; Leahy, K.; Zagora, Sophia; Younan, Christine; Fung, Adrian T.; Nguyen, Patrick Viet-Quoc; Lertsumitkul, Somsak

doi:10.1016/j.ajo.2018.03.032

Cited by 26 publications

(21 citation statements)

References 27 publications

(33 reference statements)

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“…Our survey also reaffirmed the role of ATT in the resolution of inflammation in intraocular TB. This has been described in a number of retrospective studies including recent multicentred trials, though the quality of evidence in this field is compromised by the lack of appropriate controls and grading of inflammation [ 8 , 9 ]. The participants also identified need for prolonged immunosuppression as a prognostic factor for the resolution of inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…The main strength of this study is the enumeration of prognostic factors for a disease, where such data are not available in current literature and would be difficult to derive directly from patient data. While recent multi-centre studies have attempted to evaluate prognostic factors for intraocular TB based on patient data, they have been limited by the lack of standardization, control groups and evaluation of individual phenotypes [ 8 , 9 ]. The modified Delphi technique used in this survey largely eliminated any bias or any dominating influence of individuals as typically occurs in face-to-face meetings.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey

Basu

Nora

Rao

et al. 2020

Eye

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Background Prognostic factors for TB-associated uveitis (TBU) remain mostly unknown, due to the challenges in interpretation of patient data. We present consensus list of prognostic factors for resolution of inflammation in TBU, by experts across the Asia-Pacific region. Methods We applied a modified Delphi technique to generate consensus on prognostic factors influencing the resolution of inflammation in TB-associated: anterior uveitis (AU), retinal vasculitis (RV), and multifocal serpiginoid choroiditis (MSC). The initial questionnaire was developed through a face-to-face meeting. Sixteen uveitis experts from eleven Asia-Pacific countries were included. A single investigator circulated the questionnaire electronically and received the responses. Participants scored each item on 4-point Likert scale, in three successive rounds. After each round, a number of items were reduced based on response, and summary of responses was provided to participants. At the end of Round 3, items were considered significant if they: (1) achieved a median ≥2, and interquartile range ≤1, and (2) ≥75% of the respondents agreed on whether the item was a positive or negative prognostic factor. Results Forty-two putative questionnaire items were considered. At the end of Rounds 3, 4, 9, and 8 items in AU, RV, and MSC, respectively, met significance criteria. These included duration of disease, previous corticosteroid/immunosuppressive therapy, co-existent HIV, disease-specific imaging features, multidrug resistant TB, and duration of anti-TB therapy. Conclusions Consensus were achieved on multiple ocular and systemic factors that influence resolution of inflammation in TBU. These will form the groundwork for validation in prospective clinical trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey

Basu

Nora

Rao

et al. 2020

Eye

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“…Various series have reported the use of oral corticosteroids along with ATT as a combination (oral prednisolone 1 mg/kg/ day) for IOTB with favorable control of inflammation [23,36,37,68,76,77,82]. Corticosteroids can be tapered over the next 6-12 weeks depending upon the severity of inflammation and occurrence of paradoxical worsening of the disease [83]. Certain authors favor the use of corticosteroids only when the lesions are involving or threatening the macula in order to decrease macular scarring [84].…”

Section: Managing Inflammation In Intraocular Tuberculosis-oral Cortimentioning

confidence: 99%

Infectious uveitis: an Asian perspective

Agarwal

Aggarwal

Gupta

2018

Eye

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Several intraocular infections can present with protean manifestations posing major diagnostic and management challenges. Infections such as tuberculosis, dengue and chikungunya fever have continued to remain major endemic diseases that are associated with uveitis in the Asia Pacific region. These entities often require a high index of clinical suspicion and laboratory analysis including assays of ocular fluids and/or tissues for confirmation of the diagnosis. Infectious uveitis caused by tuberculosis, dengue and chikungunya can present with characteristic clinical features and imaging findings on ancillary investigations; that may provide clue to the early diagnosis. Use of modern imaging modalities such as enhanceddepth imaging optical coherence tomography, optical coherence tomography angiography and ultra-wide field fundus photography greatly aid in the evaluation of these conditions. In the current review, we have discussed the epidemiology, clinical phenotypes, imaging characteristics, diagnosis and management of uveitis caused by tuberculosis, dengue and chikungunya.

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“…A meta-analysis has shown that 84% (95% CI 79–89) of the patients receiving ATT showed non-recurrence of inflammation during the follow-up period, 69% (95% CI 33–96) had an improvement in visual acuity, and 92% (95% CI 63–100) showed an improvement in inflammation [43]. In a cohort of patients attending uveitis clinics in London and Sydney, it was found that treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB [45].…”

Section: Introductionmentioning

confidence: 99%

Paradoxical reactions in ocular tuberculosis

Ganesh

Abraham

Sridharan

2019

J Ophthal Inflamm Infect

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Paradoxical reactions following initiation of anti-tubercular therapy have been documented most often in extrapulmonary tuberculosis. A combination of factors such as delayed hypersensitivity, decreased suppressor mechanisms, and an increased response to mycobacterial antigens mediated by the host’s immune system have been implicated in the development of these reactions. Similar worsening in patients with ocular tuberculosis while on treatment has been described. It is therefore important for the clinician to be aware of this occurrence, as prompt recognition and timely institution of corticosteroids and immunosuppressants can lead to restoration of vision. In these patients, an alteration or discontinuation of anti-tubercular therapy may not be indicated.

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Effect of Antituberculous Therapy on Uveitis Associated With Latent Tuberculosis

Abstract: Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB.

Cited by 26 publications

References 27 publications

Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey

Prognostic factors for TB-associated uveitis in the Asia-Pacific Region: results of a modified Delphi survey

Infectious uveitis: an Asian perspective

Paradoxical reactions in ocular tuberculosis

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