The Collaborative Ocular Tuberculosis Study (COTS), supported by the International Ocular Inflammation Society, International Uveitis Study Group and Foster Ocular immunological society, set up an international, expert-led consensus project to develop evidence and experience-based guidelines for the management of tubercular uveitis (TBU).
The absence of international agreement on the use of anti-tubercular therapy (ATT) in patients with TBU contributes to a significant heterogeneity in the approach to the management of this condition.
Consensus statements for the initiation of ATT in TBU were generated using a two-step modified Delphi technique. In Delphi step 1, a smart web-based survey based on background evidence from published literature, was prepared to collect the opinion of 81 international experts on the use of ATT in different clinical scenarios. The survey included 324 questions related to tubercular anterior uveitis (TAU), intermediate uveitis (TIU), panuveitis (TPU) and retinal vasculitis (TRV) administered by the experts after which the COTS group met in November 2019 for a systematic and critical discussion of the statements in accordance to the second round of the modified Delphi process.
Forty-four consensus statements on the initiation of ATT in TAU, TIU, TPU and TRV were obtained, based on ocular phenotypes suggestive of TBU and corroborative evidence of tuberculosis (TB), provided by several combinations of immunological and radiological test results. Experts agreed on initiating ATT in TAU (recurrent episodes), TIU, TPU and active TRV in the presence of positive results for any one of the immunologic tests along with radiologic features suggestive of past evidence of TB infection. In cases with first episode of TAU, and patients with inactive TRV, consensus to initiate ATT was reached only if both immunological tests and radiological tests were positive.
COTS consensus guidelines were generated based on the evidence from published literature, specialists’ opinion and logic construction, to address the initiation of ATT in TBU. The guidelines also should inform public policy by adding specific types of TBU to the list of conditions which should be treated as TB.
Copyright © 2020. Published by Elsevier Inc.