Advances in Tuberculosis-associated Uveitis

Malalis, Julia F.; Goldstein, Debra A.

doi:10.1097/iio.0000000000000065

Cited by 5 publications

(3 citation statements)

References 26 publications

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“…This could be a confounding factor for treatment failure if the predominant ocular strain differs from that isolated from systemic TB foci because the systemic strain often guides the choice of ATT. 43 However, drug sensitivity is not typically established in TB uveitis given the associated risks and low yield of cultures and polymerase chain reaction analyses of ocular fluids 49,[54][55][56][57] and will remain a limitation of prospective analysis in the foreseeable future. 49,58,59 Furthermore, given the lack of control group analysis and specific study of individual phenotypes, these results are not generalizable to all patients with TB uveitis.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Regardless of these limitations, this study had strengths of standardized inclusion and diagnostic criteria and a large and diverse cohort of patients. 4,[14][15][16][17][18][19] The multinational approach of COTS-1 is particularly relevant in improving the understanding of TB uveitis given that previous reports 4, 57 have described regional variation in disease expression. This study has also highlighted pertinent considerations for future prospective studies to better define the phenotypes, management, and outcomes of TB uveitis through standardized recruitment and treatment protocol.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)–1

et al. 2017

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; for the Collaborative Ocular Tuberculosis Study (COTS)-1 Study Group IMPORTANCE Eradication of systemic tuberculosis (TB) has been limited by neglected populations and the HIV pandemic. Whereas ocular TB often presents as uveitis without any prior evidence of systemic TB, the existing uncertainty in the diagnosis of TB uveitis may perpetuate missed opportunities to address systemic TB. OBJECTIVE To examine the clinical features of TB uveitis and the associations with response to antitubercular therapy (ATT). DESIGN, SETTING, AND PARTICIPANTS This retrospective multinational cohort study included patients from 25 ophthalmology referral centers diagnosed with TB uveitis and treated with ATT from January 1, 2004, through December 31, 2014, with a minimum follow-up of 1 year. MAIN OUTCOMES AND MEASURES Treatment failure, defined as a persistence or recurrence of inflammation within 6 months of completing ATT, inability to taper oral corticosteroids to less than 10 mg/d or topical corticosteroid drops to less than 2 drops daily, and/or recalcitrant inflammation necessitating corticosteroid-sparing immunosuppressive therapy. RESULTS A total of 801 patients (1272 eyes) were studied (mean [SD] age, 40.5 [14.8] years; 413 [51.6%] male and 388 [48.4%] female; 577 [73.6%] Asian). Most patients had no known history (498 of 661 [75.3%]) of systemic TB. Most patients had bilateral involvement (471 of 801 [58.8%]). Common clinical signs reported include vitreous haze (523 of 1153 [45.4%]), retinal vasculitis (374 of 874 [42.8%]), and choroidal involvement (419 of 651 [64.4%]). Treatment failure developed in 102 of the 801 patients (12.7%). On univariate regression analysis, the hazard ratios (HRs) associated with intermediate uveitis (HR, 2.21; 95% CI, 1.07-4.55; P = .03), anterior uveitis (HR, 2.68; 95% CI, 1.32-2.35; P = .006), and panuveitis (HR, 3.28; 95% CI, 1.89-5.67; P < .001) were significantly higher compared with posterior distribution. The presence of vitreous haze had a statistically significant association (HR, 1.95; 95% CI, 1.26-3.02; P = .003) compared with absence of vitreous haze. Bilaterality had an associated HR of 1.50 (95% CI, 0.96-2.35) compared with unilaterality (HR, 1 [reference]), although this finding was not statistically significant (P = .07). On multivariate Cox proportional hazards regression analysis, the presence of vitreous haze had an adjusted HR of 2.98 (95% CI, 1.50-5.94; P = .002), presence of snow banking had an adjusted HR of 3.71 (95% CI, 1.18-11.62; P = .02), and presence of choroidal involvement had an adjusted HR of 2.88 (95% CI, 1.22-6.78; P = .02). CONCLUSIONS AND RELEVANCE A low treatment failure rate occurred in patients with TB uveitis treated with ATT. Phenotypes and test results are studied whereby patients with panuveitis having vitreous and choroidal involvement had a higher risk of treatment failure. These findings are limited by retrospective methods. A prospectively derived composite clinical risk score might address this diagnostic uncertainty through holistic and stand...

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Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)–1

et al. 2017

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“…The severe ocular in ammation due to TB uveitis causes irreversible impairment of visual acuity. 5,6 There have been several reports of TB uveitis prevalence among causes of ocular in ammation in Japan. Ohguro et al 7 reported that the prevalence of TB uveitis was 1.4% among all types of ocular in ammation, while Goto et al 8 reported that its prevalence was 0.7%, indicating that the proportion of TB associated ocular in ammation in Japan is lower than that reported in India 9,10 or Bangladesh.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of ocular inflammation among patients with active tuberculosis or nontuberculous mycobacterial infections in a tertiary hospital in Japan: a retrospective observational study

Ohara¹,

Harada²,

Hiyama³

et al. 2020

Preprint

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Background This study aimed to elucidate the prevalence of ocular involvement among patients with active tuberculosis (TB) or nontuberculous mycobacterial (NTM) infection in a Japanese hospital.Materials and Methods Patients with active TB or NTM infection at Yoshijima Hospital from April 2017 to July 2018 were included in this retrospective study. All patients underwent ophthalmic examinations, including fundus evaluation under pupil dilation, before initiation of antibiotic therapy. Patients with ocular inflammation were regularly followed up by ophthalmologists.Results In total, 101 patients with active TB and 27 patients with active NTM infection underwent ophthalmic examinations during the study period. No ocular symptoms were reported. Seven patients with TB (6.9%) had ocular inflammation; four had bilateral involvement. In these seven patients, ocular inflammation comprised retinal vasculitis (n=2), anterior uveitis (n=2), choroiditis (n=2), and vitritis (n=1). Female sex was associated with higher prevalence of ocular inflammation among patients with TB. Conversely, no patients with NTM infection had ocular inflammation.Conclusion Ocular inflammation was present in approximately 7% of patients with active TB. Although TB choroiditis is presumed to be rare in Japan, approximately 30% of the patients with ocular inflammation exhibited choroidal lesions in this study. In contrast, no ocular inflammation was observed among patients with systemic NTM infection.

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Intravitreal dexamethasone implant as an option for anti-inflammatory therapy of tuberculosis uveitis

et al. 2018

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Advances in Tuberculosis-associated Uveitis

Cited by 5 publications

References 26 publications

Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)–1

Clinical Features and Outcomes of Patients With Tubercular Uveitis Treated With Antitubercular Therapy in the Collaborative Ocular Tuberculosis Study (COTS)–1

Prevalence of ocular inflammation among patients with active tuberculosis or nontuberculous mycobacterial infections in a tertiary hospital in Japan: a retrospective observational study

Intravitreal dexamethasone implant as an option for anti-inflammatory therapy of tuberculosis uveitis

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