Controversies in ocular tuberculosis. Issue 1 (4th November 2016) - Ang, Marcus
Abstract : Ocular tuberculosis still remains a presumptive, clinical diagnosis in the presence of supportive clinical signs and investigations, while in the absence of other possible causes of uveitis. The purpose of this review is to discuss three controversies of ocular tuberculosis today. First, it is unclear from many reports on how the diagnosis of ocular tuberculosis was defined, and if they included 'probable' or 'possible' diagnoses. Thus, there is a need to standardise the terminology used for ocular tuberculosis to allow for comparisons among studies. Second, the investigative approach is heterogeneous worldwide and there is currently no agreement on the pathogenesis of ocular tuberculosis. A suggested clinical approach involves first identifying supportive ocular signs, followed by a step-ladder approach of using various investigations such as nucleic acid amplification tests and interferon-γ release assays, before confirming a 'definite' case of ocular tuberculosis. Third, there are currently no guidelines for the commencement or duration of antitubercular therapy in patients with ocular tuberculosis. The current review highlights the need for a collaboration from ophthalmologists around the world to establish a consensus on the terminology, guidelines on first-line investigations to use and guidance on antitubercular and corticosteroid therapy for ocular tuberculosis.