Collaborative Ocular Tuberculosis Study (COTS)-1 addressed the knowledge deficits through collaboration amongst uveitis specialists across the globe by sharing the data of patients with ocular TB presented at participating centers from January 2004 to December 2014. Data collection was facilitated by a novel method of real-time encrypted web-based data entry allowing regular updates as new data and recommendations become available.
Information on clinical features, investigation findings, management and treatment outcomes were reviewed to get an idea about real world scenario. The mean age of presentation was found to be 41.3 with predominance of males (52.9%), Asian ethnicity (74.4%) and Asian geographical origin (61.5%); consistent with previous reports. Only 23.3% showed any known history of systemic TB at the time of diagnosis of ocular TB. Overall, it emerged that PCR was not a commonly used tool in COTS-1 and it was performed only in a small subset of patients. Diagnostic and management uncertainties highlighted by the study raise the need for future prospective studies to better assess ocular TB clinical features and to enhance the study of management and treatment outcomes of ocular TB through standardized recruitment and treatment protocol. To date, there are no randomized controlled trials that have defined the diagnosis nor the management of ocular TB. Furthermore, there are no consensus guidelines among the uveitis experts regarding the treatment of ocular TB, including duration of ATT, ATT regime and also regarding the concurrent use of oral corticosteroids and immunomodulatory therapy (either systemic or local). In addition, there is no multicenter study on TB that highlights differences in practice across the globe.
These observations underscore the need for multinational prospective data collection and analysis in collaboration with pulmonary and/or infectious disease specialists to directly manage and address these uncertainties. COTS-1 hence prompted us to initiate COTS CON- A Collaborative Ocular Tuberculosis Study Consensus (COTS CON) study - an international, expert led consensus initiative with the aim of developing systematic, evidence and experience-based recommendations for the treatment of ocular TB, consolidating the expertise of international uveitis specialists on an accepted approach to the management of ocular TB.