Management Of Ocular Tuberculosis Research Articles

Diagnosis and biomarkers for ocular tuberculosis: From the present into the future.

Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis (Mtb) and can manifest both pulmonary and extrapulmonary disease, including ocular tuberculosis (OTB). Accurate diagnosis and swift optimal treatment initiation for OTB is faced by many challenges combined with the lack of standardized treatment regimens this results in uncertain OTB outcomes. The purpose of this study is to summarize existing diagnostic approaches and recently discovered biomarkers that may contribute to establishing OTB diagnosis, choice of anti-tubercular therapy (ATT) regimen, and treatment monitoring. The keywords ocular tuberculosis, tuberculosis, Mycobacterium, biomarkers, molecular diagnosis, multi-omics, proteomics, genomics, transcriptomics, metabolomics, T-lymphocytes profiling were searched on PubMed and MEDLINE databases. Articles and books published with at least one of the keywords were included and screened for relevance. There was no time limit for study inclusion. More emphasis was placed on recent publications that contributed new information about the pathogenesis, diagnosis, or treatment of OTB. We excluded abstracts and articles that were not written in the English language. References cited within the identified articles were used to further supplement the search. We found 10 studies evaluating the sensitivity and specificity of interferon-gamma release assay (IGRA), and 6 studies evaluating that of tuberculin skin test (TST) in OTB patients. IGRA (Sp = 71-100%, Se = 36-100%) achieves overall better sensitivity and specificity than TST (Sp = 51.1-85.7%; Se = 70.9-98.5%). For nuclear acid amplification tests (NAAT), we found 7 studies on uniplex polymerase chain reaction (PCR) with different Mtb targets, 7 studies on DNA-based multiplex PCR, 1 study on mRNA-based multiplex PCR, 4 studies on loop-mediated isothermal amplification (LAMP) assay with different Mtb targets, 3 studies on GeneXpert assay, 1 study on GeneXpert Ultra assay and 1 study for MTBDRplus assay for OTB. Specificity is overall improved but sensitivity is highly variable for NAATs (excluding uniplex PCR, Sp = 50-100%; Se = 10.5-98%) as compared to IGRA. We also found 3 transcriptomic studies, 6 proteomic studies, 2 studies on stimulation assays, 1 study on intraocular protein analysis and 1 study on T-lymphocyte profiling in OTB patients. All except 1 study evaluated novel, previously undiscovered biomarkers. Only 1 study has been externally validated by a large independent cohort. Future theranostic marker discovery by a multi-omics approach is essential to deepen pathophysiological understanding of OTB. Combined these might result in swift, optimal and personalized treatment regimens to modulate the heterogeneous mechanisms of OTB. Eventually, these studies could improve the current cumbersome diagnosis and management of OTB.

Lessons in Digital Epidemiology from COTS-1: Coordinating Multicentre Research across 10 Countries Using Operational and Technology Innovation to Overcome Funding Deficiencies

ABSTRACTPurpose: There is controversy regarding the diagnosis and management of ocular tuberculosis (TB) due to lack of robust evidence. The Collaborative Ocular Tuberculosis Study (COTS) was conducted in stages to enable swift, accurate data collection across 25 participating centers.Method: Data collection was facilitated by a cloud-based data aggregation platform with programmed logic based on anecdotal evidence from uveitis experts corroborated with literature review. Results: The platform enabled standardization of interpretation and collection of data from patient medical records. The pre-programmed logic also ensured the platform only prompted the entry of relevant data based on initial data entered for each unit of analysis. This enabled collection of the vast amounts of data without compromising either of the breadth nor the depth of data collection.Conclusion: The final output from this effort was an in-depth retrospective analysis to facilitate the design of future prospective investigations on ocular TB and develop best practice guidelines.

Ocular tuberculosis: Where are we today?

Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.

Developing a pathway for the diagnosis and management of ocular tuberculosis. The pan-LOndon Ocular tuberculosis Pathway-LOOP.

Developing a pathway for the diagnosis and management of ocular tuberculosis. The pan-LOndon Ocular tuberculosis Pathway-LOOP.

A rare case of tuberculous choroidal abscess

We report a case of ocular tuberculosis which presented as a subretinal abscess along with an active choroiditis patch and disc edema but with subtle ocular symptoms. Patient had a strongly positive Tuberculin Skin Testing but negative Interferon Gamma Release Assay. Based on the diagnosis of presumed ocular tuberculosis the patient was started on Category 1 Anti tuberculous therapy with a tapering dose of oral steroids, to which the patient responded in 4 weeks with complete resolution of lesions. This is a rare manifestation of ocular tuberculosis with panoramic uniocular manifestations in an immunocompetent male which healed rapidly without any residual damage. This case is reported to emphasize the importance of early detection and management of ocular tuberculosis as it aids in lesser ocular morbidity and visual impairment.

Lack of Consensus in the Diagnosis and Treatment for Ocular Tuberculosis among Uveitis Specialists

Purpose: To assess the approach of specialists to ocular tuberculosis (TB).Methods: The American Uveitis Society (AUS) Listserv was surveyed using two clinical cases and general questions.Results: Of 196 members, 87 responded (44.4%), of whom 64 were affiliated with practices in North America, while 23 were outside of North America. The survey provided normative data on how physicians evaluate patients with uveitis as well as opinions about ocular TB. Responses varied widely on such issues as (1) the pretest probability that a patient with granulomatous panuveitis had TB uveitis (range 1–75%) or that a patient with a risk factor for TB had ocular TB (range 0–90%); (2) the optimal duration of anti-TB therapy; and (3) whether therapy should be discontinued after 2 months in nonresponders.Conclusions: Consensus is lacking among uveitis specialists for the diagnosis or management of ocular TB.

Imaging in the Diagnosis and Management of Ocular Tuberculosis

Supported by Dr Nasser Al-Rasheed Research Chair in Ophthalmology (A.M.A.E.-A.). The authors declare that they have no conflicts of interest to disclose.

Ocular Tuberculosis

We present an article on asymptomatic tuberculous choroiditis on screening. Discussions also include the manifestations, relevant investigations and management of ocular tuberculosis. Clinicians should be aware of these findings when treating such patients.

Mycobacterium-related Ocular Inflammatory Disease: Diagnosis and Management

Worldwide, there are approximately 8 million new cases and 3 million deaths from tuberculosis (TB) each year. TB affects the entire body and the eye. Although ocular TB is considered rare, its incidence has varied widely across time, patient populations, and geography. We report 2 patients with unique presentations of ocular TB and detail the treatment and outcome of the disease. Two cases of ocular inflammation, one with a medical history of systemic TB and the other, with that of presumed systemic TB, were examined. Choroidal granuloma developed in one, and scleritis developed in the other. The literature on ocular TB was comprehensively reviewed. Both patients were diagnosed with ocular TB. The histology of the systemic TB lesions was also illustrated. They responded to aggressive anti- TB and anti-inflammatory therapies. The diagnosis and management of ocular TB can pose a significant challenge. Physicians and ophthalmologists must include TB among the differential diagnoses of patients with ocular inflammatory diseases and treat ocular TB with a combination of anti-TB and immunosuppressive medications as needed. Immunosuppressive medications applied in this setting must be cautioned and only prescribed by ophthalmologists who are familiar with these agents.

Ocular tuberculosis: an update

Tuberculosis (TB) is an infectious disease responsible for significant morbidity and mortality worldwide. It is a resurgent disease in the developed world. The World Health Organization estimates that one third of the world's population is currently infected, with 9 million new cases occurring annually, leading to 3 million deaths per year (WHO Report, 2007). The disease affects the ocular anterior segment, the posterior segment, and adnexa. The purpose of this review is to describe the ocular manifestations, diagnosis and treatment of tuberculosis and to emphasize the fact that ocular tuberculosis may occur in the absence of systemic clinical activity and may mimic several clinical entities. Various studies have shown a clinical significance of purified protein derivative test results and computerized tomography of the chest while, molecular diagnostic procedures have provided a new approach to establishing the diagnosis of ocular tuberculosis. The current review focuses on the diagnostic modalities, various clinical features, and treatments for management of intraocular tuberculosis recommended in recent publications. It is an update on the manifestations and management of ocular tuberculosis.