An international group of experts recently developed evidence- and experience-based consensus guidelines to bridge the gap between clinical need and medical evidence to guide the initiation of anti-tubercular therapy (ATT) in patients with tubercular choroiditis.

The team 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 and the knowledge they acquired from the published literature, they generated and refined more than 150 preliminary consensus statements for initiating ATT in tubercular choroiditis.

The investigators established 70 consensus statements addressing the initiation of ATT in the three subtypes of tubercular choroiditis and 12 focusing on the use of adjunctive therapy. They agreed on initiating ATT in the presence of any positive immunological test and radiological feature suggestive of tuberculosis (TB). For tubercular serpiginous-like choroiditis and tuberculoma, they noted that one positive immunological test is sufficient to recommend ATT, even if there are no radiological features suggestive of TB.

Agrawal R, Testi I, Mahajan S, et al. Collaborative Ocular Tuberculosis Study (COTS) consensus guidelines on the management of tubercular uveitis – report 1: guidelines for initiating anti-tubercular therapy in tubercular choroiditis. Ophthalmology. January 10, 2020. [Epub ahead of print].