Abstract
Most patients with sight-threatening posterior uveitis eventually end up on systemic medication to control their disease. Although the more aggressive approach to the use of these drugs does offer the patient a better chance of significant visual improvement at least in the short term, this is often associated with severe systemic side-effects in both the young and older patient. Cyclosporin has become a very useful second-line agent as a steroid sparer in those patients who can tolerate it. However, it is not suitable for or effective in everyone and the other currently available drugs are often of limited effectivity or associated with major systemic sequelae. This paper summarises the therapeutic approaches currently being examined to define whether they have a role in the better management of these patients in the future. Particularly exciting is the potential for sustained intraocular drug delivery so that adequate drug levels are achieved inside the eye without the necessity for systemic administration.
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References
Rothova A, Suttorp-von Schulten MS, Frits Trefers WF, Kijlstra A . Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol 1996;80:332–6.
Barton K, Hall AJH, Rosen P, Cooling RJ, Lightman S . Systemic steroid prophylaxis for cataract surgery in patients with posterior uveitis. Ocular Immunol Inflammation 1994;2:207–16.
Towler HNA, Bates AK, Broadway DC, Lightman S . Trabeculectomy with 5-fluorouracil for glaucoma secondary to uveitis. Ocular Immunol Inflammation 1995;3:163–70.
Lightman S, Chan C . Immune mechanisms in chorioretinal inflammation in man. Eye 1990;4:345–53.
Riordan-Eva P, Lightman S . Orbital floor steroid injections in the treatment of posterior uveitis. Eye 1994;8:66–70.
Lightman S . Use of steroids and immunosuppressive drugs in the management of uveitis. Lancet 1991;338:1501–4.
Rosenbaum JT . Treatment of severe refractory uveitis with intravenous cyclophosphamide. J Rheumatol 1994;21:123–5.
Olsen NJ, Murray LM . Antiproliferative effects of methotrexate on peripheral blood mononuclear cells. Arthritis Rheum 1989;32:378–85.
Calabrese LH, Taylor JV, Wilke WS, et al. Response of immunoregulatory lymphocyte subsets to methotrexate in rheumatoid arthritis. Cleve Clin J Med 1990;57:232–41.
Holz FG, Krastel H, Breitbart A, Schwarz-Eywill M, Pezzutto A, Volcker HE . Lose-dose methotrexate treatment in non-infectious uveitis resistant to corticosteroids. Ger Ophthalmol 1992;1:142–4.
Shah SS, Lowder CY, Schmitt MA, Wilke WS, Kosmorsky GS, Meilser DM . Low-dose methotrexate therapy for ocular inflammatory disease. Ophthalmology 1992;99:1419–23.
Wilke WS, Biro JA, Segal AM . Methotrexate in the treatment of arthritis and connective tissue diseases. Cleve Clin J Med 1987;54:327–38.
Pascalis L, Pia G, Aresu G, Frongia T, Barca L . Combined cyclosporin A-steroid-MTX treatment in endogenous non-infectious uveitis. J Autoimmun 1993;6:467–80.
Hahn HJ, Kuttler B, Laube F, Emmrich F . Anti-CD4 therapy in recent-onset IDDM. Diabetes Metab Rev 1993;9:323–8.
Thurau SR, Wildner G, Reiter C, Riethmuller G, Lund OE . Treatment of endogenous uveitis with anti-CD4 monoclonal antibody: first report. Ger J Ophthalmol 1994;3:409–13.
Mochizuki M, Masuda K, Sakane T, Ito K, Kogure M, Sugion N, et al. A clinical trial of FK506 in refractory uveitis. Am J Ophthalmol 1993;115:763–9.
Sakane T, Mochizuki M, Inaba G, Masuda K . A phase II study of FK506 (tacrolimus) on refractory uveitis associated with Behçet's disease and allied conditions [in Japanese]. Ryumachi 1995;35:802–13.
Isioka M, Ohno S, Nakamura S, Isobe K, Watanabe N, Ishigatsubo Y, Tanaka S . FK506 treatment of noninfectious uveitis. Am J Ophthalmol 1994;118:723–9.
Schulman JA, Peyman EA . Intravitreal corticosteroids as an adjunct in the treatment of bacterial and fungal endophthalmitis: a review. Retina 1992;12:336–40.
Stern GA . Factors affecting the efficacy of antibiotics in the treatment of experimental post-operative endophthalmis. Trans Am Ophthalmol Soc 1993;91:775–844.
Young SH, Morlet N, Heery St, et al. High dose intravitreal ganciclovir in the treatment of cytomegalovirus retinitis. Med J Aust 1992;157:370–3.
Anand R, Nightingale SD, Fish RH, et al. Control of cytomegalovirus retinitis using sustained release of intraocular ganciclovir. Arch Ophthalmol 1993;111:223–7.
Morley M, Duker J, Ashton P, Robinson M . Replacing ganciclovir implants. Ophthalmology 1995;102:388–92.
Cheng CK, Berger AS, Pearson PA, Ashton P, Jaffee GJ . Intravitreal sustained-release dexamethasone device in the treatment of experimental uveitis. Invest Ophthalmol Vis Sci 1995;36:442–53.
Penfold P, Gyory J, Hunyor A, Billson F . Exudative macular degeneration and intravitreal traimcinolone: a pilot study. Aus NZ J Ophthalmol 1995;23:293–8.
Nussenblatt RB, Caspi R, Mahdi C, Cahn C, Roberge F, Lider O, Weiner HL . Inhibition of S-antigen induced experimental autoimmune uveoretinitis by oral induction of tolerance with S-antigen. J Immunol 1990;144:1689–95.
Dick AD, Cheng YF, Liversidge J, Forrester JV . Intranasal administration of retinal antigens suppresses retinal antigen-induced experimental autoimmune uveoretinitis. Immunology 1994;82:625–31.
Nussenblatt RB, Whitcup SM, de Smet MD, Caspi RR, Kozhich AT, Weiner HL, Vistica B, Gery I . Intraocular inflammatory disease (uveitis) and the use of oral tolerance: a status report. Ann N Y Acad Sci 1996;778:325–37.
Hohol MJ, Khoury SJ, Cook SL, Orav EJ, Hafler DA, Weiner HL . Three-year open protocol continuation study of oral tolerization with myelin antigens in multiple sclerosis and design of a phase III pivotal trial. Ann NY Acad Sci 1996;778:243–50.
Faure JP . Autoimmunity and the retina. Curr Top Eye Res 1980;2:215–302.
Caspi RR, Roberge FG, McAllister CG, El-Saied M, Kuwabara T, Gery I, Hanna E, Nussenblatt RB . T-cell lines mediating experimental autoimmune uveoretinitis (EAU) in the rat. J Immunol 1986;136:928–33.
Chanaud NP III, Vistica BP, Eugui E, Nussenblatt RB, Allision AC, Gery I . Inhibition of experimental autoimmune uveoretinitis by mycophenolate mofetil, an inhibitor of purine metabolism. Exp Eye Res 1995;61:429–34.
Roberge FG, Xu D, Chan CC, de Smet MD, Nussenblatt RB, Chen H . Treatment of autoimmune uveoretinitis in the rat with rapamycin, an inhibitor of lymphocyte growth factor signal transduction. Curr Eye Res 1993;12:197–203.
Robertson SM, Lang LS . Leflunomide: inhibition of S-antigen induced autoimmune uveitis in Lewis rats. Agents Actions 1994;42:167–72.
Sartani G, Silver PB, Strassmann G, Chan CC, Caspi RR . Suramin treatment suppresses induction of experimental autoimmune uveoretinitis (EAU) in rodents. Curr Eye Res 1995;14:887–96.
Uchio E, Kijima M, Tanaka S, Ohno S . Suppression of experimental uveitis with monoclonal antibodies to ICAM-I and LFA-I. Invest Ophthalmol Vis Sci 1994;35:2626–31.
Verbraeken H . Therapeutic pars planitis vitrectomy for chronic uveitis: a retrospective study of the long-term results. Graefes Arch Clin Exp Ophthalmol 1996;234/5:288–93.
Kroll P, Romstock F, Grenzebach UH, Wiegant W . Early vitrectomy in endogenous juvenile uveitis intermedia: a long-term study [in German]. Klin Monatsbl Augenheilkd 1995;206:246–9.
Bacskulin A, Eckardt C . Results of pars plana vitrectomy in chronic uveitis in childhood. Ophthalmologe 1993;90:434–9.
Nolle B, Eckardt C . Vitrectomy in multifocal chorioretinitis. Ger J Ophthalmol 1993;2:14–9.
Suttorp-Schulten MS, Feron E, Postema F, Kijlstra A, Rothova A . Macular grid laser photocoagulation in uveitis. Br J Ophthalmol 1995;79:821–4.
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Lightman, S. New therapeutic options in uveitis. Eye 11, 222–226 (1997). https://doi.org/10.1038/eye.1997.56
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DOI: https://doi.org/10.1038/eye.1997.56
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