National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom; Singapore Eye Research Institute, Singapore, Republic of Singapore.
Moorfields Eye Hospital and Biomedical Research Centre, Institute of Ophthalmology, University College London, London, United Kingdom.
Ophthalmology. 2021 Feb;128(2):277-287. doi: 10.1016/j.ophtha.2020.06.052. Epub 2020 Jun 27.
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.
由国际眼内炎症学会、国际葡萄膜炎研究组和福斯特眼免疫学会支持的协作性眼结核研究（COTS），成立了一个国际专家领导的共识项目，旨在为结核性葡萄膜炎（TBU）的管理制定基于证据和经验的指南。
在 TBU 患者中使用抗结核治疗（ATT）方面缺乏国际共识，导致对这种疾病的管理方法存在显著的异质性。
使用两步改良 Delphi 技术生成 TBU 中开始 ATT 的共识声明。在 Delphi 步骤 1 中，基于已发表文献中的背景证据，准备了一个基于网络的智能调查，以收集 81 名国际专家对不同临床情况下使用 ATT 的意见。该调查包括与结核性前葡萄膜炎（TAU）、结核性中间葡萄膜炎（TIU）、结核性全葡萄膜炎（TPU）和结核性视网膜血管炎（TRV）相关的 324 个问题，专家们在完成调查后，COTS 小组于 2019 年 11 月根据第二轮改良 Delphi 过程举行会议，根据系统和批判性讨论，对这些声明进行了评估。
根据提示 TBU 的眼部表型和结核的佐证证据，以及几种免疫和影像学检查结果的组合，获得了 44 条关于 TAU、TIU、TPU 和 TRV 中开始 ATT 的共识声明。专家们同意根据结核病的流行程度，在复发性 TAU、TIU、TPU 和活动性 TRV 中开始 ATT。在任何一种免疫检查呈阳性的情况下，加上影像学表现提示过去有结核感染证据，建议开始 ATT。在初次出现 TAU 的患者中，只有在免疫和影像学检查结果均为阳性的情况下，才达成开始 ATT 的共识。
COTS 共识指南是根据已发表文献中的证据、专家意见和逻辑构建生成的，旨在解决 TBU 中 ATT 的启动问题。该指南还应通过将特定类型的 TBU 添加到应视为结核病的疾病列表中，为公共政策提供信息。
