ABSTRACT
Non-infectious uveitis, an autoimmune disease that can cause severe visual impairment, can be difficult to treat. According to the prevailing hypothesis, the immune-mediated imbalance that contributes to non-infectious uveitis is primarily driven by CD4+T cells. However, recent research has shown that B cells also play a significant role in this process, participating in various ways such as antibody production, antigen presentation, and cytokine secretion in both human uveitis and experimental autoimmune uveitis models. Therapies targeting B cells have been used extensively in various autoimmune diseases. Rituximab, a B-cell inhibitor, is effective in treating noninfectious uveitis that is unresponsive to conventional corticosteroid and immunosuppressive therapy. This paper provides an overview of the involvement of B cells in non-infectious uveitis and their potential use in cellular therapies, aiming to further investigate the mechanisms and develop more effective strategies for prevention and treatment.
ABSTRACT
@#Uveitis is a clinically common refractory blinding eye disease with complicated etiology and pathogenesis that is difficult to treat and prone to recurrence. It is currently considered to be closely associated autoimmune inflammatory response. Tumor necrosis factor-α(TNF-α)acts as a key pro-inflammatory factor in development and progression of uveitis. Adalimumab(ADA)is a fully humanized recombinant anti-immunoglobulin monoclonal antibody targeting TNF-α, and exerts its biological effects by specifically binding to TNF-α and blocking its binding to tumor necrosis factor receptors(TNFR-1/TNFR-2). This paper reviews the clinical research progress on the mechanism, efficacy and safety of ADA in the treatment of non-infectious uveitis.
ABSTRACT
@#AIM:To evaluate the efficacy and safety of dexamethasone intravitreal implant for the treatment of noninfectious refractory uveitis and analyze its influence on application and dose of systemic corticosteroids and immunosuppressive agent.<p>METHODS: This was a retrospective, case series study conducted between January 2018 and September 2019, the patients with noninfectious refractory uveitis and treated with intravitreal implantation of dexamethasone intravitreal implant were included. The best corrected visual acuity(BCVA), central retinal thickness(CRT), vitreous haze score, and intraocular pressure(IOP)at 1mo, 2mo, 4mo and 6mo after the implantation of dexamethasone intravitreal implant were compared with the baseline. Meanwhile, the dosage of corticosteroids and immunosuppressive agent used before and after the implantation of dexamethasone was also evaluated. The data was displayed as mean±standard deviation and analyzed using the paired <i>t</i>-test.<p>RESULTS: A total of 19 patients(21 eyes)were included in the present study. The mean baseline BCVA of the included patients was 0.671±0.469, while the mean CRT was 369.667±177.100μm, and the mean intraocular pressure(IOP)was 14.252±3.181mmHg. One month, 2mo, 4mo and 6mo after the injection of Ozrudex, BCVA was significantly improved compared with the baseline(<i>P</i><0.05), while the CRT and vitreous haze score were significantly reduced(<i>P</i><0.05,<i> P</i><0.05). During the follow-up period, IOP of several patients significantly increased, but normal IOP can be observed at the end of the follow-up for all included patients. At baseline, 6 patients(6 eyes)were treated with systemic corticosteroids with an average dosage of 35.8mg/d, while only 2 patients were treated with systemic corticosteroids at the end of the 6mo follow-up(5mg/d). Apart from 3 eyes with Behcet's disease which showed recurrence of macular edema between 4-6mo, no other patient underwent that. <p>CONCLUSION: Dexamethasone intravitreal implantis considered to be a safe and effective approach for non-infectious refractory uveitis which can reduce systemic medication, with significant improvement of BCVA, reduction of CRT, vitreous haze score and the dosage of systemic corticosteroids.
ABSTRACT
@#Macular edema(ME)is a typical non-specific complication of uveitis, one of the common causes of visual impairment in patients with non-infectious uveitis(NIU). The treatment of uveitis related ME is still challenging in clinic. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combating uveitis related ME. However, there is not enough evidence to support the efficacy of any of these agents. Intravitreal dexamethasone implant(IDI, Ozurdex©; Allergan Inc, Irvine, CA)is a widely administered corticosteroid for the long-term management of uveitic ME in certain cases. Recent studies have demonstrated that IDI effectively improves uveitis related ME, and this effect could be sustained for at least six months with close monitoring and retreatment, as needed. Currently, we reviewed major clinical studies about IDI in eyes with NIU and briefly overviewed their results.
ABSTRACT
@#Uveitis has been generally defined as the inflammation occurring in the intraocular tissues. Among them, non-infectious uveitis is a T cell-mediated autoimmune inflammatory response. Through systemic treatments for non-infectious uveitis are abundant, the main principle is to suppress the immune response. In this review, we reviewed the history of non-infectious uveitis systemic therapy, detailed the current status of systemic treatment, summarized the pros and cons of each treatment regimen, and expected some new treatments for non-infectious uveitis.
ABSTRACT
@#Dexamethasone intravitreal implant is a biodegradable dexamethasone(DEX)0.7mg slow-release implant that progressively dissolves in the vitreous gel. DEX implant now is approved for macular edema(ME)secondary to retinal vein occlusion(RVO), diabetic macular edema(DME)and non-infectious uveitis(NIU). The most common treatment-emergent adverse events are intraocular pressure(IOP)elevation and cataract. Therefore, DEX implant is still second choice level in treatment of RVO-ME and DME. It is reasonable to switch to DEX implant when anti-vascular endothelial growth factor(VEGF)therapy fail. However, DEX implant may be recommended as a first choice for selected cases, such as for pseudophakic eyes, anti-VEGF-resistant eyes, or patients reluctant to receive intravitreal injections frequently. Recent studies suggest dexamethasone implant is safely and effectively improves uveitis-related ME but the role of DEX implant in the management of NIU has yet to be defined. This article reviews the recent progress of DEX implant and focusing on its efficacy and safety.