July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Collaborative Ocular Tuberculosis Study (COTS) Consensus guidelines on initiating antitubercular therapy in intermediate uveitis and panuveitis
Author Affiliations & Notes
  • Ilaria Testi
    Department of Ophthalmology, University of Padova, Padova, Italy
  • Rupesh Vijay Agrawal
    Tan Tock Seng Hospital, Singapore, Singapore
    Nanyang Technological University, Singapore, Singapore
  • Sarakshi Mahajan
    Byers Eye Institute, Stanford Medical School, California, United States
  • Dhananjay Raje
    MDS Bioanalytics, India
  • Aniruddha Agarwal
    Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • Dinesh Gunasekeran
    Tan Tock Seng Hospital, Singapore, Singapore
  • John H Kempen
    Massachusetts Eye and Ear Harvard Medical School, Massachusetts, United States
  • Quan Dong Nguyen
    Byers Eye Institute, Stanford Medical School, California, United States
  • Carlos Pavesio
    Moorfields Eye Hospital, London, United Kingdom
  • Vishali Gupta
    Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • Footnotes
    Commercial Relationships   Ilaria Testi, None; Rupesh Agrawal, None; Sarakshi Mahajan, None; Dhananjay Raje, None; Aniruddha Agarwal, None; Dinesh Gunasekeran, None; John Kempen, None; Quan Nguyen, None; Carlos Pavesio, None; Vishali Gupta, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 862. doi:
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      Ilaria Testi, Rupesh Vijay Agrawal, Sarakshi Mahajan, Dhananjay Raje, Aniruddha Agarwal, Dinesh Gunasekeran, John H Kempen, Quan Dong Nguyen, Carlos Pavesio, Vishali Gupta; Collaborative Ocular Tuberculosis Study (COTS) Consensus guidelines on initiating antitubercular therapy in intermediate uveitis and panuveitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):862.

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

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Abstract

Purpose : Presumed intra-ocular tuberculosis (IOTB) is difficult to manage due to heterogeneous presentations, mixed ocular tissue involvement and lack of international consensus on investigations and management. The Collaborative Ocular Tuberculosis Study (COTS) consensus (CON) was a survey-based investigation that consolidated the expertise of international uveitis experts on the approach to the management of presumed IOTB.

Methods : The questionnaire was pre-programmed on online smart form based on five different clinical phenotype including intermediate and panuveitis, two laboratory test and one radiological test, endemicity of the patient and recurrence of the disease. After a detailed systematic review of the literature and the acknowledgment of correlated levels of evidence, 81 experts administered the survey, hence generating consensus statements about the initiation of ATT in patients with presumed TB intermediate and panuveitis, using a modified Delphi technique. A median score of 5 with interquartile range (IQR) of 0,1 and 2 were considered good, moderate and fair consensus, respectively, for initiating ATT.

Results : From the overall analysis, consensus to initiate ATT was reached in patients with presumed TB intermediate and panuveitis, both from endemic and non-endemic region, with two immunological and one radiological test positive (median 5; IQR 0, 1) or with one immunological (either interferon gamma release assay – IGRA - or tuberculin skin test – TST) and one radiological test positive (median 5; IQR 1, 2). Consensus to initiate ATT in patients with presumed TB panuveitis irrespective of endemicity was also reached with only two immunological tests positive among experts practising in non-endemic region or amongst the experts with more than 20 years of experience in practicing uveitis (median 5; IQR 1, 2).

Conclusions : COTS consensus guidelines on initiation of ATT in intermediate and panuveitis were developed to address the conundrum related to the management of presumed IOTB.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

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