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Current Opinion in Ophthalmology May 2007This review summarizes current nonsteroidal drug therapies for noninfectious posterior and intermediate uveitis. (Review)
Review
PURPOSE OF REVIEW
This review summarizes current nonsteroidal drug therapies for noninfectious posterior and intermediate uveitis.
RECENT FINDINGS
Continuing evidence shows that second-line agents including antimetabolites, T-cell inhibitors and alkylating agents, are effective in many patients, allowing reduction in steroid dose and preservation of visual function. There is an increased use of mycophenolate mofetil. Biologic therapies, including the antitumour necrosis factor-alpha agents and interferons, have demonstrated a high degree of efficacy in controlling uveitis refractory to immunosuppressants.
SUMMARY
There are an increasing number of treatment options. As the vast majority of published studies in uveitis are case series or nonrandomized trials, there remains a lack of level 1 evidence to guide the choice and duration of therapy. Standard initial treatment for steroid-resistant disease is to add a single immunosuppressant to the regime, with additional agents being substituted or added as required. Combination of two immunosuppressants in addition to steroids may be indicated especially in chronic uveitis. High cost and limited long-term experience with biologic agents have restricted their use to uveitis refractory to immunosuppressants, but evidence suggests a potential therapeutic role earlier in Bechet's disease.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Humans; Uveitis, Intermediate; Uveitis, Posterior
PubMed: 17435428
DOI: 10.1097/ICU.0b013e3281107fef -
Indian Journal of Ophthalmology 2010Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous,... (Review)
Review
Posterior uveitic entities are varied entities that are infective or non-infective in etiology. They can affect the adjacent structures such as the retina, vitreous, optic nerve head and retinal blood vessels. Thorough clinical evaluation gives a clue to the diagnosis while ancillary investigations and laboratory tests assist in confirming the diagnosis. Newer evolving techniques in the investigations and management have increased the diagnostic yield. In case of diagnostic dilemma, intraocular fluid evaluation for polymerase chain testing for the genome and antibody testing against the causative agent provide greater diagnostic ability.
Topics: Anti-Inflammatory Agents; Choroiditis; Diagnosis, Differential; Fluorescein Angiography; Fundus Oculi; Humans; Infections; Prognosis; Retinitis; Tomography, Optical Coherence; Uveitis, Posterior
PubMed: 20029144
DOI: 10.4103/0301-4738.58470 -
Retina (Philadelphia, Pa.) Jul 2022To study the utility of MultiColor confocal scanning laser ophthalmoscope imaging (MCI) in identifying the morphology of uveitic lesions compared with conventional color... (Observational Study)
Observational Study
PURPOSE
To study the utility of MultiColor confocal scanning laser ophthalmoscope imaging (MCI) in identifying the morphology of uveitic lesions compared with conventional color fundus photography (CFP) in patients with posterior uveitis.
METHODS
In this prospective observational study, subjects with posterior uveitis underwent MCI and CFP. The images obtained by the two modalities were analyzed by two independent reviewers for vitreoretinal surface abnormalities, retinal fluid and hemorrhages, and depth/location of lesions. These findings were compared with the clinical findings and other imaging techniques.
RESULTS
Sixty-nine eyes of 43 patients (25 men) with mean age of 33.5 ± 13.9 years were studied. MultiColor imaging had better sensitivity and specificity in detecting vitreoretinal interface abnormalities, such as epiretinal membrane and inner retinal striae, compared with CFP. MultiColor imaging failed to detect retinochoroiditis lesions in 5 of 6 eyes (83%) and choroiditis in 9 46 eyes (20%), which were detected on CFP and clinical examination. Also, MCI showed a high false-positive rate of 34% in detecting intraretinal hemorrhages.
CONCLUSION
Retinochoroidal lesions in posterior uveitis may be poorly identified on MCI compared with CFP and clinical examination. One must exercise caution in commenting on disease morphology based on MCI alone.
Topics: Adult; Fluorescein Angiography; Fundus Oculi; Humans; Lasers; Male; Middle Aged; Ophthalmoscopes; Ophthalmoscopy; Retrospective Studies; Tomography, Optical Coherence; Uveitis, Posterior; Young Adult
PubMed: 35723923
DOI: 10.1097/IAE.0000000000003444 -
Die Ophthalmologie Apr 2023Noninfectious posterior uveitis (NPU) comprises a heterogeneous group of vision-threatening, immune-mediated ocular and systemic diseases. It is predominantly bilateral...
Noninfectious posterior uveitis (NPU) comprises a heterogeneous group of vision-threatening, immune-mediated ocular and systemic diseases. It is predominantly bilateral and recurrent and, if not treated properly, leads to severe tissue damage that threatens the eyesight. In industrialized countries ca. 10-20% of all cases of blindness are caused by NPU. An NPU can occur at any age but is most common between the ages of 20 and 50 years. Laboratory diagnostic and imaging procedures enable an increasingly better differentiation of the disease spectrum. This makes it possible to better assess the course and prognosis of individual disease entities. An increasing repertoire of systemic and intravitreal forms of treatment has already led to more favorable long-term treatment outcomes. It can be expected that further progress can be achieved with better knowledge of the pathophysiology of the different clinical disorders and appropriate, targeted treatment.
Topics: Humans; Young Adult; Adult; Middle Aged; Uveitis, Posterior; Intravitreal Injections; Eye
PubMed: 37022476
DOI: 10.1007/s00347-023-01833-5 -
Canadian Journal of Ophthalmology.... Feb 2020
Topics: Animals; Bites and Stings; Eye Infections, Bacterial; Female; Fluorescein Angiography; Fundus Oculi; Humans; Middle Aged; Mycobacterium tuberculosis; Parrots; Tomography, Optical Coherence; Tuberculosis, Ocular; Uveitis, Posterior
PubMed: 31712020
DOI: 10.1016/j.jcjo.2019.04.010 -
Klinische Monatsblatter Fur... Apr 2011Infectious aetiologies represent the largest entity in patients affected by posterior uveitis. As a single diagnosis, ocular toxoplasmosis ist the most frequently... (Review)
Review
Infectious aetiologies represent the largest entity in patients affected by posterior uveitis. As a single diagnosis, ocular toxoplasmosis ist the most frequently diagnosed infectious entity, wheres Behçet's uveitis represents the most frequently encountered immunologic aetiology. In acute posterior uveitis, an exact clinical diagnosis is sometimes prohibited by a dense vitreal infiltration. In this situation, the clinical course and progression of the disease may help in the differential diagnosis. Rapidly progressive instances such as viral retinal necrosis may be differentiated from cases of ocular toxoplasmosis and Behçet's disease, which tend to present in the office within one to two weeks of symptoms, and from other more slowly progressive diseases such as mycotic or nematode infections. The clinical picture at presentation is influenced by the duration of disease, underlying systemic conditions, and by the natural course of disease including the healing process and scare formation. Generally, visual function has to be assumed at risk, if a lesion is located close to the macula, if frequent recurrences increase the likelihood of macular involvement and, furthermore, if secondary complications affect the macula, e. g., macular oedema. In paediatric cases, the risk of amblyopia is frequently under-estimated, namely in the context of persistent dense vitreal infiltration. Therefore, a rapid interdisciplinary clinically tailored diagnostic access has to be reinforced in order to establish an early, targeted and etiologically based therapeutic strategy including steroid-sparing immunomodulating agents and possibly surgical alternatives.
Topics: Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Eye Infections; Humans; Uveitis, Posterior
PubMed: 21484627
DOI: 10.1055/s-0031-1273219 -
Seminars in Arthritis and Rheumatism Feb 2011To analyze the effectiveness of immunosuppressants and biological therapies in autoimmune posterior uveitis, chronic anterior uveitis associated with juvenile idiopathic... (Review)
Review
OBJECTIVES
To analyze the effectiveness of immunosuppressants and biological therapies in autoimmune posterior uveitis, chronic anterior uveitis associated with juvenile idiopathic arthritis, and macular edema.
METHODS
Systematic review. We conducted a sensitive literature search in Medline (from 1961) and EMBASE (from 1980) until October 2007. Selection criteria were as follows: (1) population: autoimmune posterior uveitis, chronic anterior uveitis in juvenile idiopathic arthritis, and macular edema; (2) intervention: immunosuppressive and biologic therapies; (3) outcomes: visual acuity, Tyndall, vitreous haze, macular edema, pars planitis, and retinal vasculitis. There were no limitations regarding study design. The quality of each study was evaluated using the Jadad's scale and Oxford Levels of Evidence.
RESULTS
Two hundred sixty-five articles were selected for detailed review of the 4235 found in the initial search: 128 records were on immunosuppressants, 105 on biological therapies, and 32 on macular edema. Overall, both the immunosuppressive and the biologic therapies appeared effective in the treatment of autoimmune posterior uveitis, except for daclizumab in uveitis related to Behçet's disease, and for etanercept in any uveitis. In the treatment of macular edema, the drugs tested were also effective.
CONCLUSIONS
Based on the evidence collated, immunosuppressants and biological therapies (except for daclizumab in Behçet and etanercept) may be effective in autoimmune uveitis and macular edema. No superiority may be inferred from this review.
Topics: Antibodies, Monoclonal; Arthritis, Juvenile; Autoimmune Diseases; Humans; Immunosuppressive Agents; Macular Edema; Treatment Outcome; Uveitis, Anterior; Uveitis, Posterior
PubMed: 20656330
DOI: 10.1016/j.semarthrit.2010.05.008 -
Indian Journal of Ophthalmology Sep 2020Ocular tuberculosis (TB) is a form of extra-pulmonary TB, which can involve almost any intraocular structure or ocular adnexa. Posterior uveitis, the commonest form of...
Ocular tuberculosis (TB) is a form of extra-pulmonary TB, which can involve almost any intraocular structure or ocular adnexa. Posterior uveitis, the commonest form of intraocular TB manifests as choroidal tubercles, choroidal tuberculoma, subretinal abscess, neuroretinitis, or serpiginous-like choroiditis. These forms of posterior tubercular lesions can be broadly classified into two groups based on their pathophysiology and morphology. One group of lesions is related to the direct invasion and reactivation of the bacilli in the choroidal tissue, whereas the other is a result of hypersensitivity reaction to the bacilli. Simultaneous bilateral active posterior uveitis with such varying morphology and pathophysiology in either eye of the same patient is an extremely rare presentation. We report a case with pulmonary TB on Anti-tubercular therapy (ATT), who presented to us with two mutually exclusive and distinctly different forms of tubercular posterior uveitis in either eye simultaneously. Both lesions were active at the time of presentation.
Topics: Antitubercular Agents; Choroiditis; Humans; Retrospective Studies; Tuberculosis, Ocular; Uveitis; Uveitis, Posterior
PubMed: 32823477
DOI: 10.4103/ijo.IJO_1251_20 -
Ocular Immunology and Inflammation Dec 2023To describe the long-term prevalence of ocular complications and visual prognosis in patients with pediatric uveitis.
PURPOSE
To describe the long-term prevalence of ocular complications and visual prognosis in patients with pediatric uveitis.
METHODS
Demographics, etiology and location of uveitis, type of complications, treatment and visual outcomes were recorded in 296 children at first examination and at 1-, 2-, 3-, 5- and 10-year time points.
RESULTS
Αnterior uveitis represented 53.4% of cases, followed by intermediate (28.0%), posterior uveitis (11.1%) and panuveitis (7.4%). The leading diagnoses were idiopathic uveitis (31.1%), juvenile idiopathic arthritis (27.0%) and pars planitis (22.6%). Posterior synechiae was the most frequent complication of anterior uveitis and panuveitis, cystoid macular edema and disc edema of intermediate and posterior uveitis respectively. Posterior uveitis and panuveitis had more severe final vision loss (23.1% and 20% respectively).
CONCLUSIONS
This study provides clinical characteristics and main complications in a longitudinal long-term follow-up of a large non-infectious pediatric uveitis Greek population. Early diagnosis and close monitoring remain of fundamental importance.
Topics: Child; Humans; Retrospective Studies; Uveitis; Uveitis, Posterior; Panuveitis; Vision Disorders
PubMed: 36693268
DOI: 10.1080/09273948.2022.2162422 -
Ocular Immunology and Inflammation Dec 2002To study the patterns of uveitis in various geographic regions. (Comparative Study)
Comparative Study Review
PURPOSE
To study the patterns of uveitis in various geographic regions.
METHODS
A systematic literature review was performed using the MEDLINE database, from 1966 to present. Studies that satisfied our described selection criteria were analyzed to provide a global perspective on uveitis.
RESULTS
Twenty-two studies, which were the best available representatives of Australia, North and South America, Europe, Asia, and Africa, were included in the final analysis. The distribution of uveitis cases according to the anatomical site of inflammation in the various regions, and the causes and clinical disease associations of anterior, intermediate, posterior, and pan-uveitis were studied for each of the regions and a comparative analysis was performed.
CONCLUSIONS
There are similarities and distinct differences in the patterns of uveitis in the various geographic regions. Such patterns of uveitis are influenced by combinations of geographical, environmental, and genetic factors.
Topics: Demography; Global Health; Humans; Panuveitis; Uveitis; Uveitis, Anterior; Uveitis, Intermediate; Uveitis, Posterior
PubMed: 12854035
DOI: 10.1076/ocii.10.4.263.15592