优化非感染性葡萄膜炎的药物治疗

Optimising drug therapy for non-infectious uveitis.

作者信息

Shahab Mohammad Ali, Mir Tahreem Aman, Zafar Sidra

机构信息

Aga Khan University, Karachi, Pakistan.

Johns Hopkins Wilmer Eye Institute, Baltimore, USA.

出版信息

Int Ophthalmol. 2019 Jul;39(7):1633-1650. doi: 10.1007/s10792-018-0984-1. Epub 2018 Jun 30.

Abstract

INTRODUCTION

Uveitis encompasses a wide variety of sight-threatening diseases characterized by intraocular inflammation. It is often classified as infectious and non-infectious uveitis. Unlike infectious uveitis, a distinct infectious agent cannot be identified in non-infectious uveitis and disease origin is usually autoimmune, drug related, or idiopathic.

THE ISSUE AT HAND

Non-infectious uveitis can often have a relapsing-remitting course, making it difficult to treat, and poses a significant challenge to ophthalmologists. The autoimmune nature of non-infectious uveitis warrants the use of anti-inflammatory and immunomodulatory agents for disease control. However, a subset of patients has persistent or recurrent ocular inflammation despite appropriate treatment, stressing the need for newer therapies aimed at more specific inflammatory targets such as tumour necrosis factor (TNF) alpha agents, anti-interleukin agents, and anti-interleukin receptor agents.

OBJECTIVES

This article discusses the various medical options available for the treatment of non-infectious uveitis in the light of the most recent evidence.

CONCLUSION

Successful management of non-infectious uveitis requires the clinician carefully balance advantages and disadvantages of each new and old therapy while considering individual circumstances. Counselling regarding the benefits and complications of each therapy can help patients make an informed choice.

摘要

引言

葡萄膜炎包括多种以眼内炎症为特征的威胁视力的疾病。它通常分为感染性葡萄膜炎和非感染性葡萄膜炎。与感染性葡萄膜炎不同,在非感染性葡萄膜炎中无法确定明确的感染病原体,其疾病起源通常是自身免疫性、药物相关性或特发性的。

当前问题

非感染性葡萄膜炎通常具有复发缓解病程,难以治疗,这给眼科医生带来了重大挑战。非感染性葡萄膜炎的自身免疫性质使得使用抗炎和免疫调节药物来控制疾病成为必要。然而,一部分患者尽管接受了适当治疗,仍存在持续性或复发性眼部炎症,这凸显了针对更特定炎症靶点(如肿瘤坏死因子 (TNF)α 药物、抗白细胞介素药物和抗白细胞介素受体药物)的新型疗法的必要性。

目的

本文根据最新证据讨论了可用于治疗非感染性葡萄膜炎的各种医学选择。

结论

成功管理非感染性葡萄膜炎需要临床医生在考虑个体情况时仔细权衡每种新旧疗法的利弊。关于每种疗法的益处和并发症的咨询可以帮助患者做出明智的选择。

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