A comprehensive review and update on the non-biologic treatment of adult noninfectious uveitis: part I.

Introduction: Treatment of adult, noninfectious uveitis remains a challenge for ophthalmologists around the world. The disease accounts for almost 10% of preventable blindness in the US and can be idiopathic or associated with infectious and systemic disorders. Strong evidence is still emerging to indicate that pharmacologic strategies presently used in rheumatologic or autoimmune disease may be translated to the treatment of intraocular inflammation.

A comprehensive review and update on the biologic treatment of adult noninfectious uveitis: part II.

Introduction: Treatment of adult, noninfectious uveitis remains a major challenge for ophthalmologists around the world, especially in regard to recalcitrant cases. It is reported to comprise approximately 10% of preventable blindness in the USA. The cause of uveitis can be idiopathic or associated with infectious and systemic disorders.

Review of Systemic Immunosuppression for Autoimmune Uveitis.

The purpose of this review is to comprehensively examine the various therapeutic agents available to treat autoimmune eye disease, their indications, clinical safety and recent developments. The stepladder approach is reviewed, including corticosteroid administration of various forms, classic immunomodulators, and newer biologic response modifiers. The authors present that corticosteroid monotherapy is almost never curative and carries significant side effects, while immunomodulatory therapy, when used appropriately as way to induce steroid-free remission, carries far less risk of causing long-term complications and provides greater potential of altering the immune system to induce a durable remission.

Management of pediatric uveitis.

Pediatric uveitis is a topic of special interest not only because of the unique diagnostic and therapeutic challenges but also because of the lifetime burden of vision loss if the problem is not adequately treated, as well as the economic and psychological toll on the family. Often, uveitis in children is discovered as part of a routine eye exam; this silent, insidious inflammation can be difficult to treat and can lead to further complications if not handled skillfully. Corticosteroids have long been the mainstay of therapy; however, the significant associated side effects mandate a corticosteroid-sparing therapeutic regimen in pursuit of remission.

Ocular manifestations of the potentially lethal rheumatologic and vasculitic disorders.

Vision threatening ocular inflammation may occur in patients with any of the acquired connective tissue disorders and vasculitic diseases. Additionally, the ocular inflammation may be the presenting manifestation of the disease, which leads the patient to seek medical care. Other manifestations of the potentially lethal disease may be subtle or absent, presenting the thoughtful ophthalmologist with the opportunity to make life saving discoveries.

Bromfenac alone or with single intravitreal injection of bevacizumab or triamcinolone acetonide for treatment of uveitic macular edema.

Purpose: To evaluate the efficacy of bromfenac drops alone or with a single intravitreal injection of bevacizumab (IVB) or triamcinolone acetonide (IVTA) in the treatment of uveitic macular edema (UME).

Design: Comparative case series. STUDY PARTICIPANT: Sixty-seven eyes (of 55 patients) with UME that received either bromfenac drops alone (n = 34), IVB plus bromfenac (n = 21) or IVTA plus bromfenac (n = 12).

Road to remission: a comprehensive review of therapy in uveitis.

Introduction: Although uveitis remains the third leading cause of preventable blindness in the US, the care and management of patients with uveitis and ocular inflammatory disease sit poised to make evolutionary if not revolutionary changes in the years ahead. This review serves to highlight important advances in the pharmacologic options available for the treatment of uveitis and ocular inflammation.

Areas Covered: Advances in steroid therapy (both topical and extended delivery), updates in the clinical safety of systemic immune modulation, and the emerging therapies for uveitis and ocular inflammatory disease are some of the areas covered in this review.

Pharmacotherapy of uveitis.

Importance Of The Field: The term 'uveitis' covers a broad spectrum of ocular inflammation affecting the iris, ciliary body, and/or the choroid, all of which comprise the uveal tract. Severe cases of uveitis need be treated aggressively to prevent damage caused by chronic inflammation. Untreated or poorly managed cases can lead to ciliary body dysfunction, inadequate aqueous production, chorioretinal damage, and possibly blindness.

Advocacy in personalized medicine: a developing strength in a complex space.

Multiple stakeholders play a role in the adoption of personalized medicine, including payers, patients, policy makers, diagnostic manufacturers and providers, and clinicians. These stakeholders span multiple positions, institutions and points of view, and are interested in making sure that each diagnostic launch covers a particular, sometimes contradictory, market need. A growing number of advocacy groups have emerged to unify these stakeholders in this increasingly complex marketplace.

Infliximab for the treatment of refractory scleritis.

BACKGROUND Scleritis is a potentially blinding inflammatory disorder. Standard care consists of systemic corticosteroids and immunosuppresants. The authors describe a series of 10 patients suffering from scleritis treated with the TNF inhibitor infliximab because this scleritis was refractory to standard therapy.

Emerging therapies for metabolic diseases--the focus is on diabetes and obesity.

Type 2 diabetes and obesity remain the focus of investigational drugs for metabolic disease. Only one new class of agents (Dipeptidylpeptidase 4 Inhibitors) has been approved in this field for control of blood glucose in patients with type 2 diabetes. Significant progress has been made in the elucidation of pathways of interest for new therapies in diabetes and obesity, partly through advances in human genetics that have highlighted genetic loci relevant to pancreatic beta cell dysfunction and hypothalamic control of food intake, respectively.

Intravenous daclizumab for recalcitrant ocular inflammatory disease.

Background: To evaluate outcomes of patients with recalcitrant ocular inflammation treated with intravenous daclizumab.

Methods: Retrospective case-series. Seventeen patients (33 eyes) with ocular inflammation who had failed several previous systemic immunomodulatory therapies were included in this study.

Daclizumab for treatment of birdshot chorioretinopathy.

Objective: To report the outcomes for daclizumab in the treatment of birdshot chorioretinopathy (BSCR) refractory to traditional immunomodulatory therapy (IMT).

Methods: We retrospectively reviewed medical records of 8 patients with BSCR whose disease was refractory to or who were intolerant of traditional IMT. All patients received 1 mg/kg of daclizumab intravenously at 2-week intervals initially at 1 referral uveitis practice.

The characteristic features of optical coherence tomography in posterior uveitis.

Aim: To describe the different retinal morphological characteristics that can present on optical coherence topography (OCT) in a spectrum of uveitic diseases.

Methods: We reviewed the literature and our own OCT image archive for characteristic features that may be suggestive of a particular disease process.

Results: OCT demonstrates a variety of characteristic morphological changes, some that may point towards a specific disease process.

Diagnosis of limited ophthalmic Wegener granulomatosis: distinctive pathologic features with ANCA test confirmation.

Purpose: To describe the clinical and histopathologic finding of very limited ophthalmic Wegener granulomatosis (WG).

Methods: Thirteen patients with scleritis, orbitopathy, episcleritis, and panuveitis were studied. They presented without evidence of lung or kidney disease, though eight had sinus involvement.

Biological response modifier therapy for refractory childhood uveitis.

Purpose: To evaluate the use of biological response modifiers (BRM) in the treatment of refractory childhood uveitis.

Design: Retrospective non-comparative case series of pediatric patients with uveitis treated with BRM.

Participants: 23 pediatric patients.