Recent advances in the management of non-infectious posterior uveitis
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REVIEW
Recent advances in the management of non-infectious posterior uveitis Rohan Bir Singh . Shruti Sinha . Chhavi Saini . Elsayed Elbasiony . Sahil Thakur . Aniruddha Agarwal
Received: 11 May 2020 / Accepted: 23 June 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To review the current regimens and novel therapeutic modalities in various stages of research and development for the management of non-infectious posterior uveitis (NIPU). Methods We performed a thorough review of current literature using PubMed, Google Scholar and Clinicaltrials.gov to identify the published literature about the available therapeutics and novel drugs/therapies in different stages of clinical trials. Results The current management regimen for noninfectious posterior uveitis includes corticosteroids, immunomodulatory therapies and anti-metabolites. However, NIPU requires long-term management for efficacious remission of the disease and to prevent disease relapse. Long-term safety issues associated with steroids have led to efforts to develop novel therapeutic agents including biological response modulators and immunosuppressants. The current
R. B. Singh S. Sinha C. Saini E. Elbasiony Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA 02114, USA S. Thakur Department of Ocular Epidemiology, Singapore Eye Research Center, Singapore 169856, Singapore A. Agarwal (&) Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh 160014, India e-mail: [email protected]
therapeutic agents in various stages of development include calcineurin inhibitors, biologic response modifiers and a more a comprehensive modalities like ocular gene therapy as well as novel drug delivery mechanisms for higher bioavailability to the target tissues, with minimal systemic effects. Conclusion Novel efficacious therapeutic modalities under development will help overcome the challenges associated with the traditional therapeutic agents. Keywords Non-infectious uveitis T cell inhibitors Biologics Anti-metabolites Interferons Nanocarriers
Introduction Uveitis is an inflammatory ocular pathology with diverse etiologies varying from infectious to noninfectious causes [1]. The underlying inflammatory processes primarily affect the uveal tissue, and subsequently damages the retinochoroid, optic nerve and the vitreous [2]. Among patients diagnosed with uveitis, approximately 50% have reduced vision, and 10–15% have complete vision loss [3–5]. Uveitis is classified on the basis of primary anatomical site of inflammation as per the Standardization of Uveitis Nomenclature (SUN) guidelines, and is further subcategorized according to onset, duration, course, and
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etiology [6]. Non-infectious posterior uveitis (NIPU) is a primary cause of vision loss in patients with uveitis [7]. The vision loss in NIPU is a consequence of associated macular edema, choroidal neovascular membrane formation, secondary glaucoma, vitreous
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