TY - JOUR
T1 - Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 1
T2 - Guidelines for Initiating Antitubercular Therapy in Tubercular Choroiditis
AU - Collaborative Ocular Tuberculosis Study Consensus Group
AU - Agrawal, Rupesh
AU - Testi, Ilaria
AU - Mahajan, Sarakshi
AU - Yuen, Yew Sen
AU - Agarwal, Aniruddha
AU - Kon, Onn Min
AU - Barisani-Asenbauer, Talin
AU - Kempen, John H.
AU - Gupta, Amod
AU - Jabs, Douglas A.
AU - Smith, Justine R.
AU - Nguyen, Quan Dong
AU - Pavesio, Carlos
AU - Gupta, Vishali
AU - Agarwal, Mamta
AU - Agarwal, Manisha
AU - Aggarwal, Ashutosh
AU - Aggarwal, Kanika
AU - Agrawal, Mukesh
AU - Al-Dhibi, Hassan
AU - Androudi, Sofia
AU - Asyari, Fatma
AU - Balasundaram, Manohar Babu
AU - Murthy, Kalpana Babu
AU - Baglivo, Edoardo
AU - Banker, Alay
AU - Bansal, Reema
AU - Basu, Soumyava
AU - Behera, Digamber
AU - Biswas, Jyotirmay
AU - Bodaghi, Bahram
AU - Carreño, Ester
AU - Caspers, Laure
AU - Chee, Soon Phaik
AU - Chhabra, Romi
AU - Cimino, Luca
AU - Concha del Rio, Luz Elena
AU - Cunningham, Emmett T.
AU - Land Curi, Andrè Luiz
AU - Das, Dipankar
AU - Davis, Janet
AU - DeSmet, Marc
AU - Denisova, Ekaterina
AU - Denniston, Alastair K.
AU - Errera, Marie Hélène
AU - Fonollosa, Alejandro
AU - George, Amala
AU - Goldstein, Debra A.
AU - Crosier, Yan Guex
AU - Gunasekeran, Dinesh Visva
N1 - Funding Information:
Supported by the National Institute for Health Research Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. Obtained funding: N/A
Publisher Copyright:
© 2020 American Academy of Ophthalmology
PY - 2021/2
Y1 - 2021/2
N2 - Topic: An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular choroiditis. Clinical Relevance: The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. Methods: An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like choroiditis, tuberculoma, and tubercular focal or multifocal choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. Results: Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular choroiditis. Experts agreed on initiating ATT in tubercular choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. Discussion: Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.
AB - Topic: An international, expert-led consensus initiative organized by the Collaborative Ocular Tuberculosis Study (COTS), along with the International Ocular Inflammation Society and the International Uveitis Study Group, systematically developed evidence- and experience-based recommendations for the treatment of tubercular choroiditis. Clinical Relevance: The diagnosis and management of tubercular uveitis (TBU) pose a significant challenge. Current guidelines and literature are insufficient to guide physicians regarding the initiation of antitubercular therapy (ATT) in patients with TBU. Methods: An international expert steering subcommittee of the COTS group identified clinical questions and conducted a systematic review of the published literature on the use of ATT for tubercular choroiditis. Using an interactive online questionnaire, guided by background knowledge from published literature, 81 global experts (including ophthalmologists, pulmonologists, and infectious disease physicians) generated preliminary consensus statements for initiating ATT in tubercular choroiditis, using Oxford levels of medical evidence. In total, 162 statements were identified regarding when to initiate ATT in patients with tubercular serpiginous-like choroiditis, tuberculoma, and tubercular focal or multifocal choroiditis. The COTS group members met in November 2018 to refine these statements by a 2-step modified Delphi process. Results: Seventy consensus statements addressed the initiation of ATT in the 3 subtypes of tubercular choroiditis, and in addition, 10 consensus statements were developed regarding the use of adjunctive therapy in tubercular choroiditis. Experts agreed on initiating ATT in tubercular choroiditis in the presence of positive results for any 1 of the positive immunologic tests along with radiologic features suggestive of tuberculosis. For tubercular serpiginous-like choroiditis and tuberculoma, positive results from even 1 positive immunologic test were considered sufficient to recommend ATT, even if there were no radiologic features suggestive of tuberculosis. Discussion: Consensus guidelines were developed to guide the initiation of ATT in patients with tubercular choroiditis, based on the published literature, expert opinion, and practical experience, to bridge the gap between clinical need and available medical evidence.
UR - http://www.scopus.com/inward/record.url?scp=85080055490&partnerID=8YFLogxK
U2 - 10.1016/j.ophtha.2020.01.008
DO - 10.1016/j.ophtha.2020.01.008
M3 - Article
C2 - 32115264
AN - SCOPUS:85080055490
SN - 0161-6420
VL - 128
SP - 266
EP - 276
JO - Ophthalmology
JF - Ophthalmology
IS - 2
ER -