Global prevalence and clinical outcomes of tubercular uveitis: a systematic review and meta-analysis

Alli, Hassan Dawood; Ally, Naseer; Mayet, Ismail; Dangor, Ziyaad; Madhi, Shabir A.

doi:10.1016/j.survophthal.2021.10.001

Cited by 9 publications

(5 citation statements)

References 108 publications

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“…However, since all the TBU cases in our study were treated for 9 months, we do not know if the same level of significance would have been maintained throughout the study if all participants had been treated with 6 months of anti-tubercular treatment. Although studies in which TBU cases treated for 6 months with anti-tubercular treatment reported good treatment outcomes, 7–9 , 11 Ang et al reported an eleven-fold decrease in the likelihood of recurrence of inflammation in TBU cases treated with anti-tubercular treatment for ≥ 9 months compared to cases treated < 9 months. 12 Anti-tubercular treatment is associated with significant adverse effects, including optic neuropathy, which can be minimized with a shorter duration of exposure to anti-tubercular treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment outcomes of TBU vary; this is partly due to the misdiagnosis of TBU, resistance to anti-tubercular treatment, variation in anti-tubercular treatment regimen (including treatment duration), and the variation in the concomitant corticosteroid-use to control inflammation. 7 Good recovery rates on anti-tubercular treatment with corticosteroids have been reported in individuals with presumed (93–100%) 8–10 and definite (90–92%) 3 , 11 TBU. However, lower recovery rates (24% to 67%) in presumed TBU cases have been reported.…”

Section: Introductionmentioning

confidence: 99%

“… 16 A meta-analysis of treatment outcomes reported an overall global recovery rate of 82% in TBU cases after completing anti-tubercular treatment. 7 …”

Section: Introductionmentioning

confidence: 99%

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Treatment Outcome of Tubercular Uveitis in a High TB and HIV Setting: A Prospective Cohort Study

Alli¹,

Ally²,

Mayet³

et al. 2021

OPTH

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Purpose To determine the time to resolution of inflammation in tubercular uveitis (TBU) cases on standard anti-tubercular treatment. Sub-analysis of time to resolution according to HIV status was also performed. Patients and Methods A prospective cohort study of presumed idiopathic uveitis cases >18 years underwent the tuberculin skin test, QuantiFERON-TB Gold test, and ocular tuberculosis (TB) polymerase chain reaction test. Adult TBU cases were treated with standard anti-tubercular therapy (and corticosteroids) for 9 months. Cases were followed-up for resolution of inflammation at 1.5, 3, 6, 9, 12 and 15 months post-diagnosis. Outcome measure was resolution of inflammation on ≤10 mg oral prednisone per day. Results Seventy-nine presumed idiopathic uveitis cases were enrolled in the study, 49 (62%) were diagnosed with TBU. The mean (SD) age of TBU cases at diagnosis was 41.8 (13.4) years. Using a multilevel mixed effects model, resolution was achieved at 6 months in the TBU cases (OR = 1.21; 95% CI, 1.03–1.41; P = 0.017). Using generalized estimating equations, resolution was also achieved at 6 months in the TBU cases (OR = 1.21; 95% CI, 1.05–1.39; P = 0.008). The HIV-positive cases (OR = 1.62; 95% CI, 1.13–2.31; P = 0.008) and the HIV-negative cases (OR = 1.25; 95% CI, 1.06–1.48; P = 0.009) achieved resolution at 9 months. Conclusion Resolution of inflammation in TBU cases on anti-tubercular treatment with corticosteroids was achieved at 6 months and maintained throughout the study. Our study suggests a minimum of 6 months treatment is required for significant resolution. Resolution of inflammation in HIV-positive and HIV-negative TBU cases needs to be further explored.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment Outcome of Tubercular Uveitis in a High TB and HIV Setting: A Prospective Cohort Study

Alli¹,

Ally²,

Mayet³

et al. 2021

OPTH

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“…Currently available data on ocular tuberculosis (OTB) varies widely due to the lack of specific diagnostic criteria [7]. Prevalence of ocular tuberculosis (OTB) on a global scale is estimated to account for 4.0% (95% CI 3.0-5.0%) of all uveitis cases and isreported to be one of the leading causes of infectious uveitis, ranging from 22.9-48.0% in Indonesiaand India [8][9][10]. OTB can affect almost all parts of the eye and may cause sight-threatening complications, such as glaucoma, cataract, and cystoid macular edema in the absence of swift and appropriate treatment [11].…”

Section: Background Of the Clinical Problems 1epidemiology Of Tubercu...mentioning

confidence: 99%

Diagnosis and biomarkers for ocular tuberculosis: From the present into the future

Ludi¹,

Sule²,

Samy³

et al. 2023

Theranostics

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Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis (Mtb) and can manifest both pulmonary and extrapulmonary disease, including ocular tuberculosis (OTB). Accurate diagnosis and swift optimal treatment initiation for OTB is faced by many challenges combined with the lack of standardized treatment regimens this results in uncertain OTB outcomes. The purpose of this study is to summarize existing diagnostic approaches and recently discovered biomarkers that may contribute to establishing OTB diagnosis, choice of anti-tubercular therapy (ATT) regimen, and treatment monitoring. The keywords ocular tuberculosis, tuberculosis, Mycobacterium, biomarkers, molecular diagnosis, multi-omics, proteomics, genomics, transcriptomics, metabolomics, T-lymphocytes profiling were searched on PubMed and MEDLINE databases. Articles and books published with at least one of the keywords were included and screened for relevance. There was no time limit for study inclusion. More emphasis was placed on recent publications that contributed new information about the pathogenesis, diagnosis, or treatment of OTB. We excluded abstracts and articles that were not written in the English language. References cited within the identified articles were used to further supplement the search. We found 10 studies evaluating the sensitivity and specificity of interferon-gamma release assay (IGRA), and 6 studies evaluating that of tuberculin skin test (TST) in OTB patients. IGRA (Sp = 71-100%, Se = 36-100%) achieves overall better sensitivity and specificity than TST (Sp = 51.1-85.7%; Se = 70.9-98.5%). For nuclear acid amplification tests (NAAT), we found 7 studies on uniplex polymerase chain reaction (PCR) with different Mtb targets, 7 studies on DNA-based multiplex PCR, 1 study on mRNA-based multiplex PCR, 4 studies on loop-mediated isothermal amplification (LAMP) assay with different Mtb targets, 3 studies on GeneXpert assay, 1 study on GeneXpert Ultra assay and 1 study for MTBDRplus assay for OTB. Specificity is overall improved but sensitivity is highly variable for NAATs (excluding Ivyspring

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“…The prevalence of ocular TB (OTB) among uveitis patients varies between 3% in non-highburden settings and 7%-11% in high-burden settings. 2 The decision to initiate antitubercular treatment (ATT) in presumed OTB cases, based on positive interferon-gamma release assay (IGRA) or tuberculin skin test (TST) results without clinically active systemic TB, remains challenging. Experts recommend starting ATT in patients with tubercular choroiditis, serpiginous-like choroiditis (SLC) or tuberculoma, who also display signs of systemic TB infection based on positive IGRA, TST or chest radiological features suggestive of TB.…”

Section: Introductionmentioning

confidence: 99%

Relapse in ocular tuberculosis: relapse rate, risk factors and clinical management in a non-endemic country

Putera,

ten Berge,

Thiadens

et al. 2024

Br J Ophthalmol

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AimsTo assess the risk of uveitis relapse in ocular tuberculosis (OTB) following clinical inactivity, to analyse clinical factors associated with relapses and to describe the management strategies for relapses.MethodsA retrospective study was conducted on a 10-year patient registry of patients with OTB diagnosed at Erasmus MC in Rotterdam, The Netherlands. Time-to-relapse of uveitis was evaluated with Kaplan-Meier curve and risk factors for relapses were analysed.Results93 OTB cases were identified, of which 75 patients achieved clinical inactivity following treatment. The median time to achieve uveitis inactivity was 3.97 months. During a median follow-up of 20.7 months (Q1–Q3: 5.2–81.2) after clinical inactivity, uveitis relapse occurred in 25 of these 75 patients (33.3%). Patients who were considered poor treatment responders for their initial uveitis episode had a significantly higher risk of relapse after achieving clinical inactivity than good responders (adjusted HR=3.84, 95% CI: 1.28 to 11.51). 13 of the 25 relapsed patients experienced multiple uveitis relapse episodes, accounting for 78 eye-relapse episodes during the entire observation period. Over half (46 out of 78, 59.0%) of these episodes were anterior uveitis. A significant number of uveitis relapse episodes (31 episodes, 39.7%) were effectively managed with topical corticosteroids.ConclusionsOur results suggest that approximately one-third of patients with OTB will experience relapse after achieving clinical inactivity. The initial disease course and poor response to treatment predict the likelihood of relapse in the long-term follow-up. Topical corticosteroids were particularly effective in relapse presenting as anterior uveitis.

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Global prevalence and clinical outcomes of tubercular uveitis: a systematic review and meta-analysis

Cited by 9 publications

References 108 publications

Treatment Outcome of Tubercular Uveitis in a High TB and HIV Setting: A Prospective Cohort Study

Treatment Outcome of Tubercular Uveitis in a High TB and HIV Setting: A Prospective Cohort Study

Diagnosis and biomarkers for ocular tuberculosis: From the present into the future

Relapse in ocular tuberculosis: relapse rate, risk factors and clinical management in a non-endemic country

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