Persistent Inflammation After Anti-Tubercular Therapy in Tubercular Serpiginous-Like Choroiditis - A Multivariate and Network-Based Risk Analysis

Sep 28, 2026

Study objectives focus on identifying risk factors for persistent inflammation after anti-tubercular therapy (ATT) in patients with tubercular serpiginous-like choroiditis (TB-SLC). A retrospective review included consecutive TB-SLC patients who completed at least 6 months of ATT, with persistent inflammation at ATT completion as the primary outcome. Multivariate logistic regression evaluated risk factors, and categorical network analysis explored relationships among key clinical variables. Total immunosuppressive load quantified systemic and local corticosteroid exposure.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Purpose

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Risk analysis approaches

Total immunosuppressive load

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Introduction

Uveitis Persistent Inflammation After Anti-Tubercular Therapy in Tubercular Serpiginous-Like Choroiditis: A Multivariate and Network-Based Risk Analysis Natasha Kesav 1,2,*, Shabtab Nasir 1,*, Mohammed Hasnat Ali3, Rashi Taori Sawal4, Ritesh Narula5, Mudit Tyagi 1,5, and Soumyava Basu 1 1 Saroja Rao Center for Uveitis, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, India 2 Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA 3 Clinical Epidemiology and Biostatistics, LV Prasad Eye Institute, Hyderabad, India 4 ABO Eye Institute, Nagpur, India 5 Anant Bajaj Retina Institute, LV Prasad Eye Institute, Hyderabad, India Correspondence: Soumyava Basu, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500033, [India. e-mail:](India. e-mail: basu@lvpei.org)[ basu@lvpei.org](India. e-mail: basu@lvpei.org) Received: July 31, 2025 Accepted: November 18, 2025 Published: December 29, 2025 Keywords: ocular tuberculosis; serpiginous-like choroiditis; antitubercular therapy; persistent inflammation; total immunosuppressive load Citation: KesavN, Nasir S, Ali MH, Sawal RT, Narula R, Tyagi M, Basu S. Persistent inflammation after anti-tubercular therapy in tubercular serpiginous-like choroiditis: A multivariate and network-based risk analysis. Transl Vis Sci Technol. 2025;14(12):27, [https://doi.org/10.1167/tvst.14.12.27](https://doi.org/10.1167/tvst.14.12.27) Purpose: Antitubercular therapy (ATT) for tubercular serpiginous-like choroiditis (TB-SLC) is well-established, but not infallible. In this study, we investigated the risk factors underlying persistent inflammation after ATT in TB-SLC patients. Methods: We retrospectively reviewed consecutive TB-SLC patients, who completed ≥6 months of ATT. The primary outcome measure was persistent inflammation atthe completion of ATT. The risk factors for persistent inflammation were analyzed using multivariate logistic regression. Additionally, a categorical network analysis was performed to explore the relationships among key clinical variables. The antiinflammatory therapy was quantified as total immunosuppressive load (TIL) by scoring systemic and local corticosteroid treatments. Results: Sixty-five patients, 71%(n = 46) males, with a median age of 33 ± 11.1 years, 45%(n = 29) bilateral, were included. Twelve patients (18.5%; 17 eyes [18.1%]) had ongoing inflammation at the conclusion of ATT. In multivariate regression analysis, the mean TIL at month 1 (adjusted odds ratio, 0.64; 95% confidence interval, 0.43–0.97; P = 0.04) and persistent inflammation at month 3 of ATT (adjusted odds ratio, 13.44; 95% confidence interval, 1.61–111.92; P = 0.02) were risk factors for persistent inflammation after ATT. Network analysis revealed strong mutual associations among low 1-month TIL, persistence at 3 months, paradoxical worsening, and 6-month ATT duration. Conclusions: Initial immunosuppression offers protection, and ongoing inflammation during therapy increases the risk of persistent inflammation after ATT. Paradoxical worsening and shorter ATT duration may affect these risk factors. Translational Relevance: Persistent inflammation after antitubercular therapy for tubercular serpiginous-like choroiditis is mainly determined by nonmicrobial factors, most notably the level of immunosuppression at the start of antitubercular therapy. Introduction Serpiginous-like choroiditis (SLC) is among the recognized manifestations of ocular tuberculosis (TB) in the Standardization of Uveitis Nomenclature criteria for tubercular uveitis.1 TB-SLC is characterized by multifocal and/or placoid lesions with active, amoeboid margins affecting the choroid, retinal pigment epithelium, and the outer retina.2 , 3 The disease activity at presentation and in response to treatment can be monitored noninvasively on autofluorescence imaging.4 , 5 Treatment for TB-SLC involves antitubercular therapy (ATT) and aggressive corticosteroid Copyright 2025 The Authors

FAQs

What was the main objective of the study?

To investigate risk factors associated with persistent inflammation after ATT in TB-SLC patients.

How was persistent inflammation defined and analyzed?

Persistent inflammation at completion of ATT was the primary outcome. Risk factors were assessed using multivariate logistic regression, with additional categorical network analysis to examine relationships among clinical variables.

Which factors were identified as risks for persistent inflammation after ATT?

Higher mean total immunosuppressive load at month 1 showed an association, while persistent inflammation at month 3 of ATT was a strong risk factor for persistence after ATT.

Sep 28, 2026

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