Tumor Necrosis Factor-Alpha Inhibitory Therapy for Non-Infectious Autoimmune Uveitis

Biologic agents represent a mainstay in the treatment of refractory non-infectious, immune-mediated uveitis. Tumor necrosis factor (TNF)-α inhibitors have demonstrated efficacy in inducing and sustaining disease remission in numerous systemic inflammatory disorders and their associated uveitic entities. In particular, studies have shown that infliximab and adalimumab can induce steroid-free disease remission in patients with Behçet’s disease and juvenile arthritis as treatments that are superior to conventional disease-modifying immunosuppressive agents. Patients receiving anti-TNF-α therapy may experience adverse events and should be closely monitored for the development of opportunistic infections, reactivation of tuberculosis and hepatitis, demyelinating disease and neuropathies, as well as malignancies

Risk Factors for the Development of Ocular Complications in Herpes Zoster Ophthalmicus

Purpose: The purpose of this study is to report the incidence of herpes zoster (HZ) and herpes zoster ophthalmicus (HZO) in a large urban hospital system and to determine risk factors that are associated with the development of ocular complications in HZO. A secondary objective is to report the frequency of shingles vaccination and any episodes of HZ reactivation following shingles vaccination in this population. Methods: A retrospective cohort study was performed on patients seen at the University of Illinois Hospital system from 2010-2015 with HZ and HZO identified by diagnosis code. Medical chart review of HZO patients seen within 1 year of diagnosis of disease was performed. Patients with any ocular complication at 6 months and 1 year time points were compared to patients without ocular complications. Multivariable logistic regression analysis was performed to determine factors associated with the development of ocular complications in HZO. Results: During the study period, 1365 patients had HZ with an incidence of 332 per 100,000; the mean age of onset was 52 years, 60% of patients were female and 38% were black. HZO with confirmed ocular involvement was seen in 122 (8.9%) patients. Of 93 patients with HZO included in the analysis, the mean age was 57.8 years, and patients were predominantly female (55.9%) and Caucasian (39.8%). Ocular complications developed in 25 (27%) patients; the most common complication was corneal scarring (24.7%). Female gender (8.9, 95%CI 2.27, 35.1) and stromal keratitis (9.69, 95% CI 2.66, 35.4) were associated with a higher odds of development of ocular complications. Shingles vaccination rates were low (0.4%) in this population during the study period, but only 4 (0.5%) patients developed reactivation of HZ following vaccination. Conclusions: HZ and HZO represent major public health issues. In HZO, female gender and stromal keratitis are strongly associated with development of ocular complications. Understanding risk factors for HZ/HZO can help to target populations for vaccination to prevent disease and long-term antiviral and anti-inflammatory therapy in those with disease

A Systematic Review of Clinical Trials in Uveitis: Lessons Learned

Clinical trials in uveitis have led to the expansion of therapeutic options for the management of non-infectious uveitis. The purpose of this systematic review is to investigate why some clinical trials have yielded successful results and regulatory approval of new therapies, and some have not. A systematic literature search of the Pubmed/MEDLINE database and clinicaltrials.gov was performed from 2006 to 2021, according to the PRISMA guidelines. Phase III clinical trials of systemic and local therapies in adults with non-infectious intermediate, posterior, and panuveitis were included. A total of 79 clinical trials were collected from ClinicalTrials.gov and PubMed/MEDLINE database search. Based on the inclusion and exclusion criteria, 14 clinical trials were included. This review summarizes the study design, outcome measures, and results of recent phase III trials in non-infectious uveitis, in the interest of understanding limitations and rethinking new methods of defining endpoints in clinical trial design.</p

Current practice in the management of ocular toxoplasmosis

Background Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. Methods 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy. Results For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%. Conclusion Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists