Department of Ophthalmology and Medicine, Oregon Health and Sciences University, Portland, OR, United States; Legacy Devers Eye Institute, Portland, OR, United States.
Department of Ophthalmology, Sorbonne University DHU ViewRestore, AP-HP, Paris, France.
Semin Arthritis Rheum. 2019 Dec;49(3):438-445. doi: 10.1016/j.semarthrit.2019.06.004. Epub 2019 Jun 10.
Non-infectious uveitis (NIU) is an immune-mediated disease with clinical symptoms such as eye pain, redness, floaters, and light sensitivity. NIU is one of the leading causes of preventable blindness.
This review describes current and emerging therapies for NIU.
PubMed searches were conducted using the terms uveitis, therapy, corticosteroids, immunomodulators, biologics, intravitreal injections, intraocular implants, and adverse events deemed relevant if they presented data relating to prevalence, diagnosis, and treatment of uveitis.
Diagnosis and management of NIU may require collaboration among different healthcare providers, including ophthalmologists and rheumatologists. Although many patients with NIU respond to corticosteroid (CS) therapy, long-term CS use can be associated with potentially severe adverse events. Localized CS therapies have been developed to reduce adverse events; however, some intravitreal injections and intraocular implants were linked to elevated intraocular pressure and cataracts. CS-sparing therapies such as biologics have demonstrated efficacy and safety while reducing CS burden. Biologics targeting tumor necrosis factor provide CS-sparing options for patients with NIU. Additional studies are needed to address long-term efficacy and safety of biologics targeting IL-6 and inhibitors of JAK/STAT.
Biologics, JAK/STAT inhibitors, and improved localized therapies may provide additional options for patients with NIU.
非感染性葡萄膜炎（NIU）是一种免疫介导的疾病，其临床症状包括眼痛、眼红、飞蚊症和畏光。NIU 是可预防失明的主要原因之一。
本综述描述了 NIU 的现有和新兴治疗方法。
使用“葡萄膜炎、治疗、皮质类固醇、免疫调节剂、生物制剂、玻璃体内注射、眼内植入物和不良事件”等术语在 PubMed 上进行检索，如果这些术语提供了与葡萄膜炎的患病率、诊断和治疗相关的数据，则认为它们与主题相关。
NIU 的诊断和管理可能需要眼科医生和风湿病学家等不同医疗保健提供者的协作。尽管许多 NIU 患者对皮质类固醇（CS）治疗有反应，但长期使用 CS 可能会引起潜在的严重不良事件。已经开发了局部 CS 疗法来减少不良事件；然而，一些玻璃体内注射和眼内植入物与眼压升高和白内障有关。CS 节约疗法，如生物制剂，在减轻 CS 负担的同时，已被证明具有疗效和安全性。针对肿瘤坏死因子的生物制剂为 NIU 患者提供了 CS 节约的选择。需要进一步的研究来解决针对 IL-6 的生物制剂和 JAK/STAT 抑制剂的长期疗效和安全性。
生物制剂、JAK/STAT 抑制剂和改良的局部疗法可能为 NIU 患者提供更多选择。
