Role of anti-tubercular therapy in management of patients with ocular tuberculosis - Collaborative ocular tuberculosis study (COTS)-I: Report 1

Session Details

Session Title: Free Paper Session 10: Uveitis

Session Date/Time: Friday 08/09/2017 | 11:00-12:30

Paper Time: 11:06

Venue: Room 111

First Author: : S.Singh INDIA

Co Author(s): :    D. Gunasekeran   R. Agarwal   R. Grant   C. Pavesio   V. Gupta   Collaborative Ocular Tuberculosis Study Group              

Abstract Details

Purpose:

Ocular tuberculosis (TB) can be the first presentation of systemic TB. It is a form of extra-pulmonary TB, which has surged due to emergence of TB and the human immunodeficiency virus (HIV) pandemic among vulnerable populations. Uncertainty in the diagnosis of TB uveitis perpetuates misdiagnoses and missed opportunities to address systemic TB infection. Clinical features of TB uveitis are described in this study and analyzed based on patients with clinical suspicion and response to anti-tubercular therapy (ATT).

Setting:

Collaborative Ocular Tuberculosis Study Group – an international multicentre initiative to set-up a registry for data on patients with Ocular Tuberculosis. This study group aims to collect good quality data that is reproducible and can be used to drive evidence-based conclusions regarding the clinical evaluation and management of Ocular Tuberculosis.

Methods:

This collaboration of 25 centres investigated 801 patients with presumed TB uveitis treated with ATT, recruited from 2004-2014. Demographics, clinical presentation and response to ATT were analyzed for all patients with a minimum follow up of 1 year. Kaplan-Meier and log rank analyses were used to identify clinical features suggestive of TB uveitis.

Results:

Patients had a mean age of 40.5 (range 4-90). They were predominantly males (n=413/801, 51.6%) of Asian ethnicity (n=577/784, 73.6%). Most patients had no symptoms (n=560/608, 92.1%) or prior known history (n=498/661, 75.3%) of systemic TB. Predominantly posterior distribution (n=294/783, 37.5%) of uveitis and its associated phenotypes are described. 96 patients (n=96/801, 12.0%) developed treatment failure. Only laterality of eye involvement (X2 = 6.13, p = 0.013), posterior uveitis (X2 = 20.5, p = 0.001), radiological imaging and vitreous cells (X2 = 4.52, p = 0.001) were significantly associated with positive response to ATT.

Conclusions:

ATT is successful in the treatment of most patients with TB uveitis. However, individual clinical features are not sufficient to diagnose TB uveitis, and a composite clinical risk score is needed.

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