Classification Criteria for Tubercular Uveitis

Abstract

Purpose: To determine classification criteria for tubercular uveitis.

Design: Machine learning of cases with tubercular uveitis and 14 other uveitides.

Methods: Cases of noninfectious posterior uveitis or panuveitis, and of infectious posterior uveitis or panuveitis, were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were analyzed by anatomic class, and each class was split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the intermediate uveitides. The resulting criteria were evaluated on the validation sets.

Results: Two hundred seventy-seven cases of tubercular uveitis were evaluated by machine learning against other uveitides. Key criteria for tubercular uveitis were a compatible uveitic syndrome, including (1) anterior uveitis with iris nodules, (2) serpiginous-like tubercular choroiditis, (3) choroidal nodule (tuberculoma), (4) occlusive retinal vasculitis, and (5) in hosts with evidence of active systemic tuberculosis, multifocal choroiditis; and evidence of tuberculosis, including histologically or microbiologically confirmed infection, positive interferon-γ release assay test, or positive tuberculin skin test. The overall accuracy of the diagnosis of tubercular uveitis vs other uveitides in the validation set was 98.2% (95% confidence interval 96.5, 99.1). The misclassification rates for tubercular uveitis were training set, 3.4%; and validation set, 3.6%.

Conclusions: The criteria for tubercular uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.

Figure 1.

Fluorescein angiogram of serpiginous-like tubercular choroiditis, demonstrating the late staining of the borders of several of the multifocal choroidal lesions.

Figure 2.

Fundus photograph of a choroidal tuberculoma with overlying serous fluid.

Figure 3.

Fundus photograph of retinal vasculitis due to tuberculosis, demonstrating intraretinal hemorrhage and vascular sheathing.