June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Anti-Tubercular Therapy in the Treatment of Tubercular Uveitis
Author Affiliations & Notes
  • Rupesh Vijay Agrawal
    Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
    Singapore Eye Research Institute, Singapore, Singapore
  • Bjorn Betzler
    Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  • Ikhwanuliman Putera
    Universitas Indonesia, Depok, Jawa Barat, Indonesia
  • Rina La Distia Nora
    Universitas Indonesia, Depok, Jawa Barat, Indonesia
  • Ilaria Testi
    Uveitis, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Onn Min Kon
    Respiratory Medicine, Imperial College London, London, London, United Kingdom
  • John H Kempen
    Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Carlos Pavesio
    Uveitis, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
  • Vishali Gupta
    Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • Footnotes
    Commercial Relationships   Rupesh Agrawal None; Bjorn Betzler None; Ikhwanuliman Putera None; Rina La Distia Nora None; Ilaria Testi None; Onn Min Kon None; John Kempen None; Carlos Pavesio None; Vishali Gupta None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3216 – A0442. doi:
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      Rupesh Vijay Agrawal, Bjorn Betzler, Ikhwanuliman Putera, Rina La Distia Nora, Ilaria Testi, Onn Min Kon, John H Kempen, Carlos Pavesio, Vishali Gupta; Anti-Tubercular Therapy in the Treatment of Tubercular Uveitis. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3216 – A0442.

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

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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.



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