Lustig Marc J, Cunningham Emmett T
Department of Ophthalmology, New York University School of Medicine, and Manhattan Eye, Ear, and Throat Hospital, New York, 10021, USA.
Curr Opin Ophthalmol. 2003 Dec;14(6):399-412. doi: 10.1097/00055735-200312000-00014.
This review summarizes current patterns in the use of immunosuppressive agents in patients with uveitis.
A number of immunosuppressive agents are currently available for the treatment of uveitis. Reports of safety and efficacy, although numerous, have been largely nonrandomized and performed without controls, limiting, to some extent, the strength and generalizability of their conclusions. Nonetheless, the volume of case reports and case series provides compelling evidence that immunosuppressive agents are effective at providing long-term control in patients with moderate to severe chronic or recurrent uveitis. The choice of immunosuppressive agent is complex, and depends on the cause and severity of the patient's underlying inflammation, the presence or absence of associated systemic inflammation, and the patient's prior response to immunosuppressive treatments.
Although corticosteroids remain the primary initial treatment for patients with uveitis, use of noncorticosteroid immunosuppressive agents in selected patients with uveitis allows for improved control and decreased risk of corticosteroid-induced side effects.
本综述总结了葡萄膜炎患者使用免疫抑制剂的当前模式。
目前有多种免疫抑制剂可用于治疗葡萄膜炎。关于安全性和有效性的报告虽然众多,但大多是非随机的且无对照,在一定程度上限制了其结论的力度和普遍性。尽管如此,病例报告和病例系列的数量提供了令人信服的证据,表明免疫抑制剂在为中度至重度慢性或复发性葡萄膜炎患者提供长期控制方面是有效的。免疫抑制剂的选择很复杂,取决于患者潜在炎症的病因和严重程度、是否存在相关的全身炎症以及患者先前对免疫抑制治疗的反应。
虽然皮质类固醇仍然是葡萄膜炎患者的主要初始治疗药物,但在选定的葡萄膜炎患者中使用非皮质类固醇免疫抑制剂可改善控制并降低皮质类固醇引起的副作用风险。