The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis

TITAN consensus guidelines group

doi:10.1038/s41433-023-02630-9

The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis

TITAN consensus guidelines group

Research output: Contribution to journal › Article (Academic Journal) › peer-review

2 Citations (Scopus)

Abstract

AIMS: To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide.

METHODS: A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used.

RESULTS: Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints.

CONCLUSIONS: Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.

Original language	English
Pages (from-to)	61-67
Number of pages	7
Journal	Eye
Volume	38
Issue number	1
Early online date	7 Jul 2023
DOIs	https://doi.org/10.1038/s41433-023-02630-9
Publication status	Published - 1 Jan 2024

Bibliographical note

Funding Information:
HNS’s work is supported by the NIH Intramural Research Program (IRP). The funding organisation had no role in the design or conduct of this research. RA has received NMRC Clinician Scientist Award from National Medical Research Council, Singapore, but the funding organisation has no role in the design or conduct of this research.

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.

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@article{80bb1d72b58048bb87573975624dd9af,

title = "The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis",

abstract = "AIMS: To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide.METHODS: A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used.RESULTS: Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints.CONCLUSIONS: Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.",

author = "Thng, {Zheng Xian} and Ikhwanuliman Putera and Ilaria Testi and Kevin Chan and Mark Westcott and Soon-Phaik Chee and Dick, {Andrew D} and Kempen, {John H} and Bahram Bodaghi and Thorne, {Jennifer E} and Talin Barisani-Asenbauer and {de Smet}, {Marc D} and Smith, {Justine R} and Peter McCluskey and {La Distia Nora}, Rina and Jabs, {Douglas A} and {de Boer}, {Joke H} and Sen, {H Nida} and Goldstein, {Debra A} and Moncef Khairallah and Davis, {Janet L} and Rosenbaum, {James T} and Jones, {Nicholas P} and Nguyen, {Quan Dong} and Carlos Pavesio and Rupesh Agrawal and Vishali Gupta and {TITAN consensus guidelines group}",

note = "Funding Information: HNS{\textquoteright}s work is supported by the NIH Intramural Research Program (IRP). The funding organisation had no role in the design or conduct of this research. RA has received NMRC Clinician Scientist Award from National Medical Research Council, Singapore, but the funding organisation has no role in the design or conduct of this research. Publisher Copyright: {\textcopyright} 2023, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.",

year = "2024",

month = jan,

day = "1",

doi = "10.1038/s41433-023-02630-9",

language = "English",

volume = "38",

pages = "61--67",

journal = "Eye",

issn = "0950-222X",

publisher = "Springer Nature",

number = "1",

}

TY - JOUR

T1 - The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis

AU - Thng, Zheng Xian

AU - Putera, Ikhwanuliman

AU - Testi, Ilaria

AU - Chan, Kevin

AU - Westcott, Mark

AU - Chee, Soon-Phaik

AU - Dick, Andrew D

AU - Kempen, John H

AU - Bodaghi, Bahram

AU - Thorne, Jennifer E

AU - Barisani-Asenbauer, Talin

AU - de Smet, Marc D

AU - Smith, Justine R

AU - McCluskey, Peter

AU - La Distia Nora, Rina

AU - Jabs, Douglas A

AU - de Boer, Joke H

AU - Sen, H Nida

AU - Goldstein, Debra A

AU - Khairallah, Moncef

AU - Davis, Janet L

AU - Rosenbaum, James T

AU - Jones, Nicholas P

AU - Nguyen, Quan Dong

AU - Pavesio, Carlos

AU - Agrawal, Rupesh

AU - Gupta, Vishali

AU - TITAN consensus guidelines group

N1 - Funding Information: HNS’s work is supported by the NIH Intramural Research Program (IRP). The funding organisation had no role in the design or conduct of this research. RA has received NMRC Clinician Scientist Award from National Medical Research Council, Singapore, but the funding organisation has no role in the design or conduct of this research. Publisher Copyright: © 2023, The Author(s), under exclusive licence to The Royal College of Ophthalmologists.

PY - 2024/1/1

Y1 - 2024/1/1

N2 - AIMS: To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide.METHODS: A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used.RESULTS: Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints.CONCLUSIONS: Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.

AB - AIMS: To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide.METHODS: A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used.RESULTS: Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints.CONCLUSIONS: Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.

U2 - 10.1038/s41433-023-02630-9

DO - 10.1038/s41433-023-02630-9

M3 - Article (Academic Journal)

C2 - 37419957

SN - 0950-222X

VL - 38

SP - 61

EP - 67

JO - Eye

JF - Eye

IS - 1

ER -

The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1-global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis

Abstract

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