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To the Editor:
We would like to thank Dr. Chaudhary and Dr. Varshney for reviewing our article1 and suggesting very pertinent points related to intraocular tuberculosis (TB) and antitubercular therapy. With regard to their first comment on 3 months of isoniazid prophylaxis, we would like to clarify that current evidence does not condone treatment with a single antitubercular therapy agent for any form of active infectious TB including ocular TB.2 The use of single-agent chemotherapy is the current practice before initiation of systemic immunosuppressive therapy in patients where immunosuppression is indicated.3 However, there is no general consensus on duration of single-agent chemotherapy.3 This represents a small group of patients who have suspected immunological manifestations of ocular TB that develop after prior completed multidrug antitubercular therapy regimens for systemic TB. We feel that for the following scenarios, single-drug prophylaxis is adequate:
These are generally a small group of patients, representing less than 5% of this cohort of patients with peripheral retinal vasculitis.
With regard to their comment on referral for patients with retinal vasculitis with low-grade inflammation to TB specialist, we will like to clarify that these were the patients not on oral steroids and had resolved or minimal inflammation not requiring oral steroids. Hence, the risk of reactivation of latent TB or development of military TB was not considered to be a problem. Furthermore, given that this study was conducted at a tertiary referral hospital, some patients had already been started on steroids in other centers before referral to our center for further assessment and management.
If TB had been the cause of the problem for these patients, they should have developed more florid disease at the time they presented to us, especially after steroid therapy.
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