The role of biologic agents in the management of non-infectious uveitis.

INTRODUCTION: Uveitis is an intriguing group of disorders characterized by inflammation of the uveal tract. Due to the potential grave consequences of the disease process, it is important to assess the various therapeutic options available for treating uveitis, and their outcomes. AREAS COVERED: This review discusses the use of conventional agents in the management of uveitis, including discussion of the molecular and clinical properties of corticosteroids, antimetabolites, calcineurin inhibitors and alkylating agents and their side effects. In addition, it also discusses the molecular and clinical properties of novel biologic agents and their side effects. Moreover, recommendations as to when biologic agents should be employed are also discussed. EXPERT OPINION: We recommend that in general (except in selected cases of Adamantiades-Behçet's disease) biologics should not be used as a first-line therapy for uveitis due to inconvenience, high cost, and potential immunosuppressive effects. However, many biologics are potent in inducing drug-free remission of uveitis and may be employed to manage recurrent diseases or diseases not responsive to conventional agents.

Macular sensitivity and fixation patterns in normal eyes and eyes with uveitis with and without macular edema.

PURPOSE: This study aims to investigate the relationship between macular sensitivity and thickness in eyes with uveitic macular edema (UME). DESIGN: This study is a prospective observational case series. METHODS: The setting for this study was clinical practice. The study included 59 (28 with UME, 31 without UME) eyes of 26 patients with uveitis and 19 eyes of 10 normal subjects. The procedure followed was fundus-related perimetry and retinal thickness map with an automated fundus perimetry/tomography system. Main outcome measures included quantification of macular sensitivity, fixation pattern, and relationship between macular sensitivity and thickness. RESULTS: Fixation stability revealed that 56 eyes (93.44%) had stable fixation (>75% within the central 2° of point of fixation); three eyes (6.56%) were relatively unstable (<75% of fixation points located within 2°, >75% located within 4°); and no eye had unstable fixation (<75% of fixation points located within 4°). Evaluation of fixation location revealed that 45 eyes (76.27%) had central fixation location (>50% of fixation point within 0.5 mm of foveal center); seven eyes (11.86%) had peri-central fixation location (25% << 50% within 0.5 mm); and seven eyes (11.86%) had eccentric (<25% of fixation point within 0.5 mm) fixation location. We measured macular sensitivity and corresponding thickness in 1,708 loci of 61 study eyes. Macular sensitivity increased by 0.02 dB (95% confidence interval, 0.00, 0.06) per 1 µm increase in the thickness for the thickness values ≤280 µm. Macular sensitivity decreased by 0.04 dB (95% CI, -0.08, -0.01) per 1 µm increase in the thickness for the thickness values >280 µm. CONCLUSIONS: Perimetry quantification of macular sensitivity and retinal thickness, in association with other factors, may offer novel information regarding the impact of UME on retinal function.