Abstract
Purpose :
To quantitatively evaluate the efficacy of anti-tubercular therapy (ATT) in tubercular uveitis (TBU) patients.
Methods :
In this systematic review and meta-analysis, a search of PubMed, EMBASE and Cochrane Library was conducted for articles on ATT outcomes in TBU published between 1st January 2000 and 1st August 2021. Study details, demographics, clinical features, investigations that led to a diagnosis of TBU, treatment regimen (ATT, corticosteroids and immunosuppressants), and information on target treatment outcomes was extracted independently by three reviewers. A meta-analysis of proportions was performed. Main outcome measures include inflammation recurrence; inflammation reduction; complete resolution of inflammation; improved visual acuity (VA); ability to taper corticosteroids to < 10 mg/day without inflammatory progression; use of adjunctive immunosuppressants while on ATT. This review is prospectively registered in PROSPERO (CRD42020206845)
Results :
Forty-nine studies reporting data for 4,017 TBU patients were included. In comparative studies, the odds ratio (OR) of inflammatory recurrence was 0.33 (95%CI: 0.19-0.60) for TBU patients treated with ATT versus no ATT. For TBU patients treated with ATT, the pooled absolute incidences of inflammatory recurrence, inflammatory reduction, complete resolution of inflammation and of visual acuity improvement were 13% (n=310/2,216; 95%CI: 9-18), 81% (n=217/276; 95%CI: 62-95), 83% (n=1,167/1,812; 95%CI: 77-89), and 65% (n=347/542; 95%CI: 51-78) respectively. Corticosteroids were tapered to <10 mg/day without inflammatory progression in 91% (n=326/395; 95%CI: 78-99) of patients, 9% (n=121/1,376; 95%CI: 6-13) of whom were administered concomitant immunosuppressive agents alongside ATT.
Conclusions :
Treatment of TBU with ATT is associated with a high level of control or improvement of inflammation, followed by a two-thirds improvement in the risk of inflammatory recurrence in TBU patients; only one-seventh of TBU patients have recurrences during follow up. Visual acuity improved in most patients. However, more prospective studies with detailed reporting of ATT regimens, patient subgroups and outcomes are required to elucidate the effectiveness of ATT about other outcome measures.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.