作者
Rupesh Agrawal,Ilaria Testi,Sarakshi Mahajan,Yew Sen Yuen,Aniruddha Agarwal,Onn Min Kon,Talin Barisani‐Asenbauer,John H. Kempen,Amod Gupta,Douglas A. Jabs,Justine R. Smith,Quan Dong Nguyen,Carlos Pavésio,Vishali Gupta,Mamta Agarwal,Manisha Agarwal,Ashutosh N. Aggarwal,Vishali Gupta,Mukesh Agrawal,Hassan Al-Dhibi,Sofia Androudi,Fatma Asyari,Manohar Babu Balasundaram,Kalpana Babu Murthy,Edoardo Baglivo,Alay Banker,Reema Bansal,Soumyava Basu,Digamber Behera,Jyotirmay Biswas,Bahram Bodaghi,Ester Carreño,Laure Caspers,Soon Phaik Chee,Romi Chhabra,Luca Cimino,Luz Elena Concha del Río,Richard Lee,André Luiz Land Curi,Dipankar Das,Janet L. Davis,Marc D. de Smet,Ekaterina V. Denisova,Alastair K. Denniston,Marie‐Hélène Errera,Alejandro Fonollosa,Amala Elizabeth George,Debra A. Goldstein,Yan Guex Crosier,Dinesh Visva Gunasekeran,Avinash Gurbaxani,Alessandro Invernizzi,Hazlita Mohd Isa,Shah M.d. Islam,Nicholas P. Jones,Deeksha Katoch,John H. Kempen,Amit Khosla,Michal Kramer,Amitabh Kumar,Atul Kumar,Rina La Distia Nora,Richard Lee,Careen Y. Lowder,Saurabh Luthra,Padmamalini Mahendradas,Dorine Makhoul,Shahana Mazumdar,Peter McCluskey,Salil Mehta,Elisabetta Miserocchi,Manabu Mochizuki,Oli S. Mohamed,Cristina Muccioli,Marion R. Munk,Somasheila Murthy,Shishir Narain,Heloísa Nascimento,Piergiorgio Neri,Myhanh Nguyen,Annabelle A. Okada,Pınar Özdal,Alan G. Palestine,Francesco Pichi,Dhananjay Raje,Sivakumar R. Rathinam,Andrés Rousselot,Ariel Schlaen,S Sehgal,Sen Hou,Aman Sharma,Kusum Sharma,Samir S. Shoughy,Nirbhai Singh,Ramandeep Singh,Masoud Soheilian,Sudharshan Sridharan,Jennifer E. Thorne,Christoph Tappeiner,Stephen C. Teoh,M.S. Tognon,İlknur Tuğal-Tutkun,Mudit Tyagi,Harvey S. Uy,Daniel Vítor Vasconcelos Santos,Nataša Vidović Valentinčič,Mark Westcott,Ryoji Yanai,Bety Yañez Alvarez,Zahedur Rahman,Manfred Zierhut
摘要
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.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.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.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.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.