Tautologies and the Telltale Tubercle Bacillus

Re: Agrawal et al.: Collaborative Ocular Tuberculosis Study Consensus Guidelines on the Management of Tubercular Uveitis—Report 1 (Ophthalmology. 2021;128:266–276)

“…TO THE EDITOR: We read the article 1 and its associated commentary 2 with immense interest and appreciate the concerns highlighted by Rosenbaum et al 2 regarding the diagnosis of ocular tuberculosis being solely based on immunologic tests. We would like to add a few comments.…”

Tubercular Retinal Vasculitis: Diagnostic Dilemma and Management Strategies

“… 4 , 6 The variability of clinical picture is only the beginning of the diagnostic riddle. 7 TB is a smoldering low-grade paucibacillary infection which is difficult to culture, more so from the intraocular issue due to inaccessibility, small sample size and inherent risk during culture harvest. 8 Gene amplification by nested or multiplex polymerase chain reaction (PCR) assay is difficult, expensive, inaccessible in clinical settings, and still unreliable.…”

“… 11 However, the expert consensus was less clear about the management of anterior or intermediate uveitis and retinal vasculitis. 7 One reason for the ambiguity was the homogenization of TRV and Eales disease as a single entity, as a manifestation of immune response to the tubercular bacillus.…”

“…Three centuries of familiarity with the tubercular uveitis and several clinical, laboratory and technological innovations later, we have still not been able to unravel the mystery of diagnosis and treatment of OTB, mainly due to the paucibacillary nature of disease, wide range of uveitis presentations and variable extent of immune-mediated response in the eye. 7 , 30 It is pertinent to note that OTB is not exclusively a developing world problem: a tertiary clinic in the USA reported an average delay of more than 2 years in the diagnosis of OTB, resulting in profound visual loss in about 40% of the patients. 38 TRV remains a particularly elusive subset of OTB with even more disputed management.…”

“…The diagnosis of ocular TB (OTB) is further muddled by the variability of clinical presentations across different ethnic and geographic populations. [4][5][6][7] Collaborative Ocular Tuberculosis Study (COTS) evolved a survey-based consensus of 81 uveitis experts across the globe to clear the murky profile of OTB: the clinically suggestive ocular features when supported by systemic presence of active or latent TB are sufficient to presumptively diagnose OTB and start antitubercular treatment (ATT). 11 However, the expert consensus was less clear about the management of anterior or intermediate uveitis and retinal vasculitis.…”