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Collaborative Ocular Tuberculosis Study (COTS) Consensus Guidelines on Initiating Antitubercular Therapy in Presumed Tubercular Choroiditis
Sarakshi Mahajan, MD
Sarakshi Mahajan, Rupesh V. Agarwal, Ilaria Testi, Dhananjay Raje, Aniruddha Agarwal, Dinesh Gunasekeran, John H. Kempen, Quan D. Nguyen, Carlos Pavesio, Vishali Gupta
Byers Eye Institute, Stanford Medical School, CA, United States
Tan Tock Seng Hospital, Singapore, Singapore
Nanyang Technological University, Singapore, Singapore
University of Padova, Padova, Italy
MDS Bioanalytics, India
Post Graduate Institute of Medical Education and Research, Chandigarh, India., Chandigarh, India
Massachusetts Eye and Ear Harvard Medical School, MA, United States
Moorfields Eye Hospital, London, United Kingdom
Purpose: The decision to initiate antitubercular therapy (ATT) for presumed tubercular choroiditis (SLC) is controversial. An international, expert-led consensus initiative by the Collaborative ocular tuberculosis study (COTS) group developed systematic, evidence and experience-based recommendations for the treatment of presumed tubercular choroiditis.
Methods: The international expert steering sub-committee through COTS group identified clinical scenarios pertinent to intraocular tuberculosis. A systematic review of the literature and assigned Oxford levels of evidence was generated for all the clinical scenarios. Using these smart online questionnaires, guided by background knowledge from published literature, the consensus statements were generated for initiating ATT using a modified Delphi technique in patients manifesting with serpiginous like choroiditis. The median score of 5 with interquartile range (IQR) of 0,1,2 and 3 were considered reaching good, moderate, fair and poor consensus respectively for initiating ATT.
Results: There was a strong consensus amongst the experts to initiate ATT in addition to the standard of care (systemic corticosteroids/ immunosuppressive therapy) in patients both from endemic and non-endemic regions with two immunological and one radiologic test positive (median 5, IQR 0); one immunologic and one radiologic test positive (median 5; IQR 0, 1) or two immunologic tests positive with radiology either not done or negative (median 5; IQR 0, 1).
Conclusions: COTS consensus guidelines were developed based on published literature, expert opinion and practical experience to bridge the gap between clinical needs and medical evidence to support the initiation of ATT in patients with presumed tubercular choroiditis.