Global Variations and Challenges With Tubercular Uveitis in the Collaborative Ocular Tuberculosis Study

Abstract

PURPOSE. The aim of this study was to examine regional variation management practices and outcomes for tubercular uveitis (TBU). METHODS.In this retrospective multinational cohort study, patients from 25 international eye care centers diagnosed with TBU with a minimum follow-up of 1 year were included. The geographic variation in treatment outcomes on survival analysis in patients with TBU were analyzed. Treatment failure is defined as a persistence or recurrence of inflammation within 6 months of completing antitubercular therapy, the inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. RESULTS.Records of 945 patients (1485 eyes) with TBU were analyzed. The mean age was 41.3 6 15.0 years (range, 4-90 years), with more males (52.9%, n ¼ 500/945) and predominant Asian ethnicity (74.4%, n ¼ 690/927). Most patients had no symptoms (92.0%, n ¼ 655/712) or history (76.7%, n ¼ 604/787) suggestive of pulmonary tuberculosis (TB). Some patients had evidence of inactive pulmonary TB on chest X-rays (26.9%, n ¼ 189/702) or chest computed tomography (68.6%, n ¼ 109/159). Patients with western geographic origin (logrank ¼ 6.47, P ¼ 0.010), African or Hispanic ethnicity (log-rank ¼ 19.9, P < 0.001), and positive immigrant status (log-rank ¼ 4.89, P ¼ 0.027) had poorer survival outcomes.CONCLUSIONS. This is a first-ever multinational analysis of TBU that highlights regional differences in treatment outcomes for this elusive form of extrapulmonary TB. Our findings will help in the design of future collaborative studies together with internists to develop best practice guidelines for this early opportunity to address TB infection and strategies to target at-risk groups such as immigrants.

Clinical and Epidemiological Study on Tubercular Uveitis in a Tertiary Eye Care Centre in Italy

“…e necessity to treat TB uveitis with ATT is controversial. Previous studies suggested that ATT treatment positively influences ocular relapses, inducing a remission of the disease in a higher number of patients, when compared with untreated group (84% and 58% of patients, respectively) [2,26]. In line with these studies, in our population, 78% of patients did not show relapses of the uveitis after ATT during the entire follow-up period [2,26].…”

“…Recently, a group of 25 ophthalmic centres analysed several clinical features in a larger cohort of TBU cases in order to identify novel and more standardized management protocols [26]. In our study, 42.9% of patients came from endemic areas, of which 91.7% were under 65 years of age.…”

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

“…guidelines. 7 Subsequently, the COTS consensus was designed as a survey-based clinical study, supported by International Ocular Inflammation Society, International Uveitis Study Group, and Foster Ocular Immunological Society, to consolidate the expertise of uveitis specialists from different regions of the world on the management of TBU. 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.…”

Commentary: Tubercular posterior scleritis - Nuances in practice!

“…What is elegantly clear in posterior scleritis caused by TB is that anti-inflammatory therapy can worsen the condition if caused by TB[78] This holds true for the polar form of TB[9] in the recent concept of TB and sarcoid as the two distinct ends of the spectrum of a same disease. The clinician should be clear that shades of different colors of the spectrum do occur in the day-to-day practice similar to a rainbow!…”