Diwo E, Sève P, Trad S, Bielefeld P, Sène D, Abad S, Brézin A, Quartier P, Koné Paut I, Weber M, Chiquet C, Errera M H, Sellam J, Cacoub P, Kaplanski G, Kodjikian L, Bodaghi B, Saadoun D
Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France.
Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Faculté de médecine Lyon-Sud, université Claude Bernard-Lyon 1, France.
Rev Med Interne. 2018 Sep;39(9):687-698. doi: 10.1016/j.revmed.2018.03.001. Epub 2018 Mar 31.
Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).
临床实践中使用的传统免疫抑制药物、抗肿瘤坏死因子α及其他生物疗法能够控制非感染性前葡萄膜炎、后葡萄膜炎和全葡萄膜炎。本研究由内科医生、风湿病学家和眼科医生等多学科专家小组牵头,基于文献综述开展。在出现皮质类固醇依赖或威胁视力的疾病时,使用传统免疫抑制药物(甲氨蝶呤、硫唑嘌呤和霉酚酸酯)和/或抗肿瘤坏死因子α(阿达木单抗、英夫利昔单抗)来实现并维持病情缓解。干扰素作为二线治疗药物,对于某些治疗指征(难治性黄斑水肿、白塞氏血管炎)是一种有效的免疫调节治疗方法。其他生物制剂,尤其是托珠单抗,显示出了有前景的结果。在单侧炎症复发的情况下,局部治疗(皮质类固醇、西罗莫司等)为辅助治疗。必须通过临床检查和反复的补充检查(激光散射光度测定法、多模态成像、视野检查、视网膜电图测量)精确评估治疗反应。