Are the SUN Criteria Sufficient for Tubercular Uveitis? Findings From a Multinational Registry Study

Purpose: The Standardization of Uveitis Nomenclature (SUN) criteria were introduced in 2021 to standardize the classification of uveitis subtypes. We evaluated the real-world applicability of these criteria for tubercular uveitis (TBU) using a computational definition mapped to the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) registry. Methods: This observational retrospective cross-sectional study analyzed real-world baseline data from 372 clinician-diagnosed TBU cases within the multinational OASIS registry, all collected from 17 tertiary centers across 8 countries: India, Nepal, Indonesia, Switzerland, Ethiopia, Colombia, Argentina, and Chile. We mapped the SUN criteria to corresponding variables in the OASIS registry, and Boolean operators were used to generate a computational definition for TBU. The sensitivity of the SUN criteria in capturing clinician-diagnosed cases of TBU was evaluated. Results: The SUN criteria identified 15.9% (n = 59) of clinician-diagnosed TBU cases at baseline. Criterion f2 (evidence of TB infection) was met in 70.7% of cases (n = 263), and criterion f1 (TBU-compatible uveitic syndrome) was satisfied in 24.5% of cases (n = 91). Exclusion criterion successfully identified 99.5% of cases (n = 370). By country and anatomical location, cases in India and those with posterior uveitis had the highest concordance at 19.8% (n = 39) and 21.8% (n = 44), respectively. Bilateral TBU was more likely to satisfy the SUN criteria (P = 0.049). Conclusions: SUN classification criteria demonstrated low sensitivity for real-world TBU diagnosis at baseline, which may limit the number of cases available for enrollment in research studies. Further diagnostic refinement, clearer definition of application context, and longitudinal validation are needed to generate diagnostic criteria for clinical application.