作者
Rupesh Agrawal,Ilaria Testi,Baharam Bodaghi,Talin Barisani‐Asenbauer,Peter McCluskey,Aniruddha Agarwal,John H. Kempen,Amod Gupta,Justine R. Smith,Marc D. de Smet,Yew Sen Yuen,Sarakshi Mahajan,Onn Min Kon,Quan Dong Nguyen,Carlos Pavésio,Vishali Gupta,Rupesh Agarwal,Ilaria Testi,Baharam Bodaghi,Talin Barisani‐Asenbauer,Peter McCluskey,Aniruddha Agarwal,John H. Kempen,Amod Gupta,Justine R. Smith,Yew Sen Yuen,Sarakshi Mahajan,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,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,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,Xian Zheng,Onn Min Kon,Quan Dong Nguyen,Carlos Pavésio,Vishali Gupta
摘要
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 antitubercular 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 2-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), tubercular intermediate uveitis (TIU), tubercular panuveitis (TPU), and tubercular 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 with 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, provided by several combinations of immunologic and radiologic test results. Experts agreed on initiating ATT in recurrent TAU, TIU, TPU, and active TRV depending on the TB endemicity. In the presence of positive results for any 1 of the immunologic tests along with radiologic features suggestive of past evidence of tuberculosis infection. In patients with a first episode of TAU, consensus to initiate ATT was reached only if both immunologic and radiologic test results were positive.The COTS consensus guidelines were generated based on the evidence from published literature, specialists' opinions, 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 that should be treated as tuberculosis.