Topic

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.

Clinical Relevance

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.

Methods

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.

Results

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.

Discussion

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.

中文翻译：

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眼部结核病协作研究共识指南关于结核性葡萄膜炎的管理——报告 1：结核性脉络膜炎开始抗结核治疗的指南。

话题

由协作性眼部结核病研究 (COTS) 与国际眼部炎症学会和国际葡萄膜炎研究组共同组织的一项由专家主导的国际共识倡议，系统地制定了基于证据和经验的结核性脉络膜炎治疗建议。

临床相关性

结核性葡萄膜炎 (TBU) 的诊断和管理是一项重大挑战。目前的指南和文献不足以指导医生对 TBU 患者开始抗结核治疗 (ATT)。

方法

COTS 小组的一个国际专家指导小组委员会确定了临床问题，并对已发表的关于使用 ATT 治疗结核性脉络膜炎的文献进行了系统评价。81 位全球专家（包括眼科医师、肺科医师和传染病医师）在已发表文献的背景知识的指导下，使用交互式在线问卷调查，使用牛津水平的医学证据，就在结核性脉络膜炎中启动 ATT 达成初步共识声明。总共确定了 162 条关于何时在结核性丝状脉络膜炎、结核瘤和结核性局灶性或多灶性脉络膜炎患者中启动 ATT 的声明。COTS 小组成员于 2018 年 11 月开会，通过两步修改的 Delphi 流程来完善这些陈述。

结果

70 份共识声明涉及 ATT 在 3 种结核性脉络膜炎亚型中的启动，此外，还制定了 10 份关于结核性脉络膜炎辅助治疗的共识声明。专家们同意在任何一项阳性免疫测试结果呈阳性以及放射学特征提示结核病的情况下，在结核性脉络膜炎中启动 ATT。对于结核性丝状脉络膜炎和结核瘤，即使 1 次免疫学检测呈阳性也足以推荐 ATT，即使没有影像学特征提示结核病。

讨论

根据已发表的文献、专家意见和实践经验，制定了指导结核性脉络膜炎患者启动 ATT 的共识指南，以弥合临床需求和现有医学证据之间的差距。