September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Collaborative Ocular Tuberculosis Study (COTS) - A global multicentre study of clinical features and factors affecting treatment outcome in intraocular tuberculosis – report 1
Author Affiliations & Notes
  • Dinesh Visva Gunasekeran
    NHG Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore, Singapore
  • Vishali S Gupta
    Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  • Carlos Pavesio
    Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
  • Robert Grant
    Health and Social Care Statistics, Centre for Health and Social Care Research, London, United Kingdom
  • Rupesh Vijay Agrawal
    NHG Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore, Singapore
    Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
  • Footnotes
    Commercial Relationships   Dinesh Gunasekeran, None; Vishali Gupta, None; Carlos Pavesio, None; Robert Grant, None; Rupesh Agrawal, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, No Pagination Specified. doi:
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      Dinesh Visva Gunasekeran, Vishali S Gupta, Carlos Pavesio, Robert Grant, Rupesh Vijay Agrawal; Collaborative Ocular Tuberculosis Study (COTS) - A global multicentre study of clinical features and factors affecting treatment outcome in intraocular tuberculosis – report 1. Invest. Ophthalmol. Vis. Sci. 201657(12):.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : This international collaboration aims to describe phenotypes suggestive of intraocular tuberculosis (IOTB) and factors affecting treatment outcomes.

Methods : 10-year retrospective analysis of patients with IOTB presenting from January 2005 to August 2014 was conducted. Inclusion criteria were a minimum follow-up of 1 year, exclusion of relevant uveitides, and diagnosis based on documented clinical signs and investigations (TB culture, polymerase chain reaction, Mantoux test, Interferon Gamma Release Assay, or chest imaging suggestive of pulmonary TB).

Clinical features, investigations and treatment regimen were collated. Visual acuity, SUN grading of anterior chamber inflammation, BIO score of vitreal inflammation, clinical severity, side-effects of anti-tubercular therapy (ATT), and treatment response were recorded at 6, 12, 18 and 24 months. Treatment failure was defined as inability to taper steroids/immunosuppressives, or recurrence of inflammation within 6 months of completing ATT.

Results : A total of 564 patients from 22 centres were included. 198 patients (35.1%) were recruited from India, 144 (25.5%) Singapore, 132 (23.4%) Europe, 50 (8.9%) Australia, 15 (2.7%) the Americas, and 25 (4.4%) other regions. Most patients were Asian (71.8%), males (52.6%) with bilateral involvement (57.3%) and no recorded systemic symptoms (88.5%) at presentation. The nature of uveitic manifestations was predominantly granulomatous (49.8%), of acute onset (48.1%) and a panuveitis distribution (35.1%). Prevalence of clinical features included snow balls (31.7%), snow banking (7.64%), disc oedema (23.9%), macular oedema (19.7%), retinal vasculitis (41.5%), and choroiditis (41.3%). The most prevalent manifestations of choroiditis were serpiginous-type choroiditis (36.5%) and choroidal tuberculoma (13.9%).
The majority of patients were started on both ATT and some form of steroid (75.4%), with some patients started on monotherapy with either ATT (8.01%) or Steroid (10.6%). Frequency of treatment failure at 6 (15.7%), 12 (10.8%), 18 (14.1%), and 24 months (12.1%) was analysed according to region and treatment regimen.

Conclusions : Epidemiology, clinical features and treatment outcomes of IOTB are described using a global database with inherent limitations of a retrospective study.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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