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P6 Ocular tuberculosis: a survey of uk clinical practice

Background Ophthalmic manifestations of tuberculosis (TB) are described as inflammatory events in one or both eyes involving the uvea, optic nerve or orbit. The diagnosis is almost always presumptive as mycobacterium are rarely cultured from ocular/periocular tissues. Ocular TB is rare in the developed world and there is a general lack of consensus regarding diagnosis and treatment duration. We surveyed UK specialists involved in the diagnosis and treatment of tuberculous uveitis to examine current clinical practice. Method A previously validated survey based on two clinical cases (one more likely to have TB, one less likely to have TB) was used to examine diagnostic and treatment practices amongst consultants from three different specialities across different institutions in the UK: ophthalmologists with an interest in uveitis, respiratory, and infectious disease (ID) physicians with a TB interest. Results Ten ophthalmologists, 24 ID and 29 respiratory physicians completed the survey. Responses varied greatly within the same specialty as well as between different specialities. For example, in a patient with chronic granulomatous panuveitis and a known TB risk factor, the pre-test likelihood of having ocular TB varied significantly within the groups: ophthalmologists (range 5%–95%), respiratory (range 20%–99%), ID (range 9%–90%). Similarly, for the same scenario, there was disagreement in the optimal duration of treatment. Whilst the majority of clinicians would treat for 6 months, 17 clinicians (24%) – ophthalmologists [3], respiratory [5], ID [9] – would treat for longer than 6 months. All 10 ophthalmologists (100%) would defer antibiotic treatment decisions to a TB specialist rather than initiate treatment themselves. All ID and respiratory physicians would screen for HIV if ocular TB was suspected, whereas only 6 (60%) of ophthalmologists would. Conclusion Diagnosis of ocular TB is challenging due to lack of a gold standard test. Expert consensus is therefore important to ensure the right patients are treated appropriately. This is the first multidisciplinary survey within the UK capturing a spectrum of opinions regarding ocular TB. The Results highlight a lack of consensus both within and between different specialties in the field. An open dialogue between relevant stakeholders is key to harmonising diagnostic and treatment strategies.