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Aniruddha Agarwal, Rupesh Vijay Agrawal, Ilaria Testi, Sarakshi Mahajan, Dinesh Visva Gunasekeran, Dhananjay Raje, John H Kempen, Quan Dong Nguyen, Carlos Pavesio, Vishali Gupta; Collaborative Ocular Tuberculosis Study (COTS) Consensus guidelines on initiating antitubercular therapy in patients with granulomatous anterior uveitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3528.
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Granulomatous anterior Uveitis (AU) can be a manifestation of various inflammatory and non-inflammatory conditions which makes the diagnosis of presumed intraocular Tuberculosis with AU as the only presenting sign a diagnostic and management conundrum. Collaborative Ocular Tuberculosis Study (COTS) aims to recommend guidelines to address this controversy on the basis of expert opinions and literature evidence for initiating antitubercular therapy (ATT) in patients with AU.
Clinical scenarios related to AU were generated by a sub-committee of experts through COTS group. Cognito Form (Cognito Form, Columbia, South Carolina) was used to generate questionnaires which were guided by level of evidence through the literature review.The quality of evidence was defined using the Oxford Center for Evidence-based medicine levels of evidence criteria grading. A modified Delphi Technique was used in patients with AU taking median score as five with interquartile range (IQR) of 0,1,2 and 3 being considered good, moderate, fair and poor consensus respectively.
81 experts participated in the modified Delphi study for presumed intraocular tuberculosis. There was a strong to fair consensus to initiate ATT in cases of AU both in endemic and non- endemic areas when both immunological tests and radiological test were positive during the first and recurrent episode. There was strong to fair consensus to treat in recurrent cases in both endemic and non- endemic areas when either one of the immunological test was positive with other either negative or not done/ available with a positive radiological test.
COTS consensus guidelines for initiating ATT in patients with granulomatous anterior Uveitis were generated using supporting literature evidence and expert opinions.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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