Tubercular uveitis (TB-uveitis) remains a conundrum in the uveitis field, which is mainly related to the diverse clinical phenotypes of TB-uveitis. Moreover, it remains difficult to differentiate whether () is present in the ocular tissues, elicits a heightened immune response without invasion in ocular tissues, or even induces an anti-retinal autoimmune response. Gaps in the immuno-pathological knowledge of TB-uveitis likely delay timely diagnosis and appropriate management. In the last decade, the immunopathophysiology of TB-uveitis and its clinical management, including experts' consensus to treat or not to treat certain conditions with anti-tubercular treatment (ATT), have been extensively investigated. In the meantime, research on TB treatment, in general, is shifting more toward host-directed therapies (HDT). Given the complexities of the host- interaction, enhancement of the host immune response is expected to boost the effectiveness of ATT and help overcome the rising burden of drug-resistant strains in the population. This review will summarize the current knowledge on the immunopathophysiology of TB-uveitis and recent advances in treatment modalities and outcomes of TB-uveitis, capturing results gathered from high- and low-burden TB countries with ATT as the mainstay of treatment. Moreover, we outline the recent progress of HDT development in the pulmonary TB field and discuss the possibility of its applicability to TB-uveitis. The concept of HDT might help direct future development of efficacious therapy for TB-uveitis, although more in-depth research on the immunoregulation of this disease is still necessary.

中文翻译：

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结核性葡萄膜炎的免疫反应及其对治疗的影响：从抗结核治疗到宿主导向治疗


结核性葡萄膜炎（TB-uveitis）仍然是葡萄膜炎领域的一个难题，这主要与结核性葡萄膜炎多样化的临床表型有关。此外，仍然很难区分（）是否存在于眼组织中，是否在不侵入眼组织的情况下引发增强的免疫反应，或者甚至诱导抗视网膜自身免疫反应。结核性葡萄膜炎免疫病理学知识的差距可能会延误及时诊断和适当的治疗。在过去的十年中，结核性葡萄膜炎的免疫病理生理学及其临床治疗，包括专家对用抗结核治疗（ATT）治疗或不治疗某些疾病的共识，已得到广泛研究。与此同时，结核病治疗的研究总体上正在更多地转向宿主导向疗法（HDT）。鉴于宿主相互作用的复杂性，宿主免疫反应的增强预计将提高 ATT 的有效性，并有助于克服人群中日益增加的耐药菌株负担。本综述将总结目前关于结核性葡萄膜炎免疫病理生理学的知识以及结核性葡萄膜炎治疗方式和结果的最新进展，收集来自以 ATT 作为主要治疗方法的高和低结核病负担国家收集的结果。此外，我们概述了 HDT 在肺结核领域的最新进展，并讨论了其应用于结核性葡萄膜炎的可能性。尽管仍需要对该疾病的免疫调节进行更深入的研究，但 HDT 的概念可能有助于指导结核性葡萄膜炎的有效治疗的未来发展。