Ocular Tuberculosis

“Anti-tuberculous therapy in a real-life clinical setting significantly reduced the number of flare-ups and enabled long-term remission in patients with presumed ocular tuberculosis.”

Tuberculosis (TB) remains a global health challenge: The World Health Organization (WHO) estimates that 10.4 million cases and 1.3 million deaths were recorded worldwide in 2016. And although Mycobacterium tuberculosis typically affects pulmonary tissue, the infection may present a myriad of extra-pulmonary manifestations. Intraocular tuberculosis presenting as posterior uveitis may be difficult to recognize by physicians working outside TB-endemic countries, as it mimics a variety of uveitis entities. 

Currently, there are no standardized diagnostic criteria for ocular tuberculosis. Instead, confirmation relies on known clinical symptoms’ patterns, tuberculin skin testing and culture, or DNA PCR of MTB in intraocular samples. Interferon gamma release assays (IGRA) are highly specific for MTB infection, but cannot differentiate between latent and active tuberculosis, thereby worsening the controversy. 

“While ocular TB, a recognized form of extra-pulmonary TB, is associated with high rates of morbidity, there is little clinical information or standard guidelines for its diagnosis,” shared Dr. Rupesh Agrawal, Adjunct Assistant Professor and Consultant Ophthalmologist, National Healthcare Group Eye Institute NHGEI), Tan Tock Seng Hospital (TTSH), Singapore, shedding light on the ocular TB dilemma. The absence of a unified guide thus poses a challenge in the diagnosis and management of the disease, emphasized Dr. Agrawal. 

The Collaborative Ocular Tuberculosis Study (COTS), a first-of-its-kind, multicenter global initiative, according to Dr. Agarwal, was established to address the challenges ocular TB care faces via cloud computing and big data.