RECENT TRENDS IN TREATMENT OF NON INFECTIOUS UVEITIS

Abstract

Uveitis is an inflammation of the uveal tract, which lines the inside of the eye behind the cornea. Much of the uvea lies between the retina and tough, outer sclera. The uveal tract has three parts: the iris, the ciliary body, and the choroid. Uveitis is categorized according to the part of the uveal tract that is affected. Anterior uveitis is an inflammation of the front part of the uveal tract; it includes inflammation of the iris (iritis) and inflammation of the iris and the ciliary body (iridocyclitis). Posterior uveitis is an inflammation of the part of the uveal tract behind the lens of the eye. It includes inflammation of the choroid (choroiditis) and inflammation of the choroid and retina (chorioretinitis). Uveitis that affects the entire uveal tract is called panuveitis or diffuse uveitis. Many cases will resolve rapidly, but a significant number of patients develop persistent disease with inflammatory damage to ocular structures resulting in severe visual impairment. The main causes of sight loss are cystoid macular edema, cataract, and glaucoma. Approximately 5-20% of legal blindness in developed countries is due to uveitis, and it has been estimated that uveitis accounts for 10-15% of all cases of total blindness in the USA. Acute anterior uveitis is the commonest subtype and carries the best visual outcome, with a worse visual prognosis seen in patients with posterior uveitis and panuveitis. The causes of uveitis are not fully understood, but they can be a result of trauma, allergy, or a response to a systemic or ocular disease. Uveitis may be a type of immune-response mechanism. In people with impaired immune systems, uveitis may be due to an infection (bacteria, virus, parasite, or fungus). For many years, uveitis was considered a single disease entity; therefore, the approach to treatment varied very little. As knowledge of the disease process grew and the sophistication of immunologic and microbiologic testing increased, the fact that uveitis entails a multitude of diseases became clear. Although some diseases are local ocular immune phenomena, many of them are systemic diseases with ocular manifestations. Because the spectrum of disease pathogenesis ranges from autoimmunity to neoplasia to viruses, the practitioner of uveitis requires an understanding of internal medicine, infectious diseases, rheumatology, and immunology. Patients with uveitis can present with some of the most challenging diagnostic dilemmas in all of ophthalmology. Because the treatment and prognosis of various uveitic entities varies greatly, accurate diagnosis is imperative. Many diseases, including Fuchs heterochromic iridocyclitis, Behçet disease, toxoplasmosis, cytomegalovirus (CMV) retinitis, ocular histoplasmosis, and Vogt-Koyanagi-Harada (VKH) disease, are clinical diagnoses that require little, if any, laboratory analysis. Likewise, the patient presenting with an initial episode of acute