The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 165 Patients with Tubercular Anterior Uveitis

Agrawal, Rupesh; Betzler, Bjorn Kaijun; Testi, Ilaria; Mbbs, Sarakshi Mahajan; Agarwal, Aniruddha; Gunasekeran, Dinesh Visva; Raje, Dhananjay; Aggarwal, Kanika; Dnb, Somasheila I Murthy; Westcott, Mark; FRCSEd, Soon-Phaik Chee; McCluskey, Peter; FRCSGlasg, Su Ling Ho; FRCSEd, Stephen Teoh; Cimino, Luca; Biswas, Jyotirmay; Agarwal, Manisha; Dnb, Padmamalini Mahendradas; Khairallah, Moncef; FRCSOphth, Nicholas Jones; Tuğal-Tutkun, İlknur; Dnb, Kalpana Babu; Basu, Soumayava; Carreño, Ester; Lee, Richard W.; Al-Dhibi, Hassan; Bodaghi, Bahram; Invernizzi, Alessandro; Goldstein, Debra A.; Herbort, Carl P.; Barisani-Asenbauer, Talin; González-López, Julio J.; Androudi, Sofia; Bansal, Reema; Moharana, Bruttendu; Esposti, Simona Degli; Tasiopoulou, Anastasia; Nadarajah, Sengal; Dnb, Mamta Agarwal; Abraham, Sharanya; Vala, Ruchi; Singh, Ramandeep; Sharma, Aman; Sharma, Kusum; Zierhut, Manfred; Mrcp, Onn Min Kon; Cunningham, Emmett T.; Kempen, John H.; Nguyen, Quan Dong; FRCSOphth, Carlos Pavesio; Gupta, Vishali

doi:10.1080/09273948.2020.1761400

Cited by 9 publications

(4 citation statements)

References 37 publications

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“…The addition of ATT to topical therapy in the management of anterior uveitis has been controversial. From the retrospective analysis of COTS 1 data related to 165 patients affected by TAU, 46 it seemed that the addition of ATT to topical treatment does not have a significant impact on the treatment outcome of patients with TBU. By contrast, multiple single-center studies highlighted the therapeutic role of ATT in patients diagnosed with TAU.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Anterior uveitis in tuberculosis may be granulomatous or nongranulomatous [59]. As with any form of anterior uveitis, there are uncharacteristic cells and an anterior chamber flare.…”

Section: Anterior Tuberculous Uveitismentioning

confidence: 99%

“…Die anteriore Uveitis bei Tuberkulose kann sowohl granulomatös als auch nicht granulomatös sein [59]. Wie bei jeder anterioren Form einer Uveitis finden sich uncharakteristische Zellen und ein Flare in der Vorderkammer.…”

Section: Anteriore Tuberkulöse Uveitisunclassified

Infektiöse posteriore Uveitis – Toxoplasmose, Treponema, Tuberkulose (TTT)

Neß

Winterhalter

Stübiger

2022

Klin Monbl Augenheilkd

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“…TAU can manifest with granulomatous or non-granulomatous inflammation, with inflammatory cells and flare seen in the anterior chamber. 48 In chronic cases, mutton-fat keratic precipitates may develop, which may decrease in size over time with successful ATT and topical steroids. Long standing anterior segment inflammation could disrupt the corneal endothelium, leading to corneal edema.…”

Section: The Clinical Spectrum Of Otbmentioning

confidence: 99%

Clinics of ocular tuberculosis: A review

Betzler

Gupta

Agrawal

2021

Clinical Exper Ophthalmology

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Ocular tuberculosis (OTB) is an extrapulmonary mycobacterial infection, which still sees variations in incidence, manifestations, diagnostic and therapeutic approaches. While the disease is gaining more recognition as a differential in ocular inflammation, it remains a difficult entity to detect and treat. Global efforts to synthesize and standardize the approach to OTB could prove useful in delivering quicker, more effective care. We summarize recent insights in appropriate nomenclature, clinical presentations, diagnostic modalities and courses of treatment.

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The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Review of 165 Patients with Tubercular Anterior Uveitis

Cited by 9 publications

References 37 publications

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

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

Infektiöse posteriore Uveitis – Toxoplasmose, Treponema, Tuberkulose (TTT)

Clinics of ocular tuberculosis: A review

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