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A Multinational Review of 251 Patients With Tubercular Retinal Vasculitis

Gunasekeran, Dinesh V.*,†,‡; Agrawal, Rupesh*,†,§; Agarwal, Aniruddha; Carreño, Ester**; Raje, Dhananjay††; Aggarwal, Kanika; Kon, Onn M.‡‡; Nguyen, Quan Dong§§; Pavesio, Carlos; Gupta, Vishali for the COTS-1 Study Group

doi: 10.1097/IAE.0000000000002194
Original Study: PDF Only

Purpose: Tubercular retinal vasculitis (TRV) is a heterogeneous disease that can be difficult to manage because of nonspecific presentation and limitations of confirmatory tests for tuberculosis. This is a big data analysis on phenotypes and treatment outcomes for TRV.

Methods: Multicentre retrospective study of patients with TRV between January 2004 and December 2014 and a minimum follow-up of 1 year.

Results: Two hundred and fifty-one patients with TRV with a mean age of 38.9 ± 14.4 years (range, 9–86 years) were included. The patients were predominantly males (n = 167/251; 66.5%) of Asian ethnicity (n = 174/246; 70.7%), and geographical origin (n = 137/251; 54.6%). Most patients had features of occlusive type of RV (n = 113/185; 61.1%) except Caucasians (n = 11; 28.2%). There was no significant difference in treatment failure whether patients received antitubercular therapy (ATT) (P = 0.29), although treatment failure was less frequent in patients who received ATT (13.6%; n = 31/228) compared with those who did not (21.7%, n = 5/23). Less treatment failures were observed in patients with occlusive type RV who received ATT; however, this was not significant on survival analysis (P = 0.09). Treatment with ATT was associated with higher failure rates in patients of Hispanic and African American race and those with TRV associated with panuveitis (compared with posterior uveitis).

Conclusion: In this multinational study of TRV, there was no significant therapeutic effect of ATT. However, a definitive conclusion about the role of ATT could not be made because of a few patients who did not receive ATT. Because this is a retrospective study with a limited 1-year follow-up, the effect of ATT may have been overestimated (or underestimated) in the duration of follow-up.

The Collaborative Ocular Tuberculosis Study group contributes this detailed review of the subset of 251 patients who had tubercular retinal vasculitis. Big data from 25 international centers is analyzed to provide insights into phenotypes and outcomes of TRV, as well as ethnic and geographic variation in phenotypic expression.

*National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore;

Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom;

School of Medicine, National University of Singapore, Singapore;

§Singapore Eye Research Institute, Singapore;

Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India;

**Department of Ophthalmology, Bristol Eye Hospital, United Kingdom;

††MDS Bioanalytics, Shankar Nagar, Nagpur, India;

‡‡Chest and Allergy Clinic, St Mary's Hospital, Imperial College Healthcare NHS Trust, United Kingdom; and

§§Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, California.

Reprint requests: Vishali Gupta, MD, Room 116, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh 160012, India; e-mail:

The research was partially funded by the National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. This sponsor supported some of the research man-hours that were contributed by all our part-time collaborators from the Moorfields Eye Hospital who are salaried as Ophthalmology clinicians by the hospital. D. A. Goldstein is supported by an unrestricted grant from Research to Prevent Blindness. V. Gupta is supported by grant from Department of Biotechnology Ministry of Health, India. J. J González-López is supported by study grants from ABBVIE, Allergan, and Angelini.

None of the authors has any conflicting interests to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

D.V. Gunasekeran and R. Agrawal are Joint first authors.

A complete listing of study group members is listed in Appendix 1.

Funders played no part in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript nor the decision to submit for publication.

© 2019 by Ophthalmic Communications Society, Inc.