Abstract
Purpose :
The heterogeneous presentations of intraocular tuberculosis (IOTB) and the global variations in investigations and treatment approach has resulted in significant discrepancies in management of IOTB. The Collaborative Ocular Tuberculosis Study (COTS) consensus (CON) was a survey-based initiative guided by international experts to address the challenges in management of presumed tubercular retinal vasculitis.
Methods :
A total of 81 globally representative experts administered an online evidence based ( assigned using Oxford levels of evidence) survey for management of presumed IOTB based on five clinical phenotypes, two immunological test and one radiological test. The results of the survey were analysed using a modified Delphi technique. In total, 108 questions were addressed for presumed tubercular retinal vasculitis, resulting in 13 evidence-based consensus statements for initiating antitubercular therapy (ATT) in patients with active and inactive presumed tubercular retinal vasculitis, both from endemic and non-endemic region. A median score of 5 with interquartile range (IQR) of 0,1, 2 and 3 were considered as good, moderate, fair and poor consensus respectively for initiating ATT.
Results :
From the overall analysis, consensus to initiate ATT was reached in patients affected by active retinal vasculitis, both from endemic and non-endemic region, with two immunological and one radiological test positive (median 5; IQR 0 and 2, respectively) or with two immunological tests positive (median 5; IQR 2 and 3, respectively) or with one immunological (either interferon gamma release assay – IGRA - or tuberculin skin test – TST) and one radiological test positive (median 5; IQR 0, 1, 2, 3). On subgroup analysis, consensus to treat patients with active retinal vasculitis both from endemic and non endemic region with two immunological tests positive was reached only among experts practicing in non-endemic region or amongst those with more than 20 years of experience in uveitis (median 5; IQR 0, 1, 2).
Conclusions :
COTS consensus guidelines for initiation of ATT in presumed tubercular retinal vasculitis have been developed addressing the lack of synchrony amongst ophthalmologists and physicians for management of this patients due to the lack of gold standard criteria for the diagnose of IOTB.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.