Petrushkin et al reported the pan-LOndon Ocular tuberculosis Pathway for evaluating a patient for ocular tuberculosis. The authors are from multple institutions in London.
Patient selection: possible ocular tuberculosis
Ocular phenotype consistent with tuberculosis:
(1) chronic granulomatous anterior uveitis
(2) choroidal granuloma
(3) serpiginous chorioretinitis
(4) peripheral occlusive vasculitis
Other high-risk phenotypes:
(1) idiopathic granulomatous uveitis with suspicion for tuberculosis
(2) nongranulomatous anterior uveitis with (other causes excluded) AND (poor response to topical therapy)
Reasons to pursue the diagnosis of tuberculosis:
(1) positive interferon gamma release assay
(2) strong clinical or epidemiological suspicion of tuberculosis
(3) positive optional investigations:(a) tuberculin skin test; (b) CT chest; (c) FDG PET scan
If it is decided to treat as tuberculosis:
(1) treat with rifampin, isoniazid, pyrazinamide AND (ethambutol OR moxifloxacin) for 2 months
(2) follow with rifampin and isonazid for 7 months
(3) evaluate at 2, 6 and 9 months after start of therapy in a tuberculosis clinic
