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与非感染性葡萄膜炎相关的黄斑水肿:病理生理学、病因、患病率、影响及管理挑战

Macular edema associated with non-infectious uveitis: pathophysiology, etiology, prevalence, impact and management challenges.

作者信息

Massa Horace, Pipis Spyros Y, Adewoyin Temilade, Vergados Athanasios, Patra Sudeshna, Panos Georgios D

机构信息

Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland.

Eye Treatment Centre, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.

出版信息

Clin Ophthalmol. 2019 Sep 10;13:1761-1777. doi: 10.2147/OPTH.S180580. eCollection 2019.

Abstract

Macular edema (ME) is the most common sight-threatening complication in uveitis. The diagnostic and therapeutic management of the uveitic macular edema (UME) might be challenging due to the complex diagnostic workup and the difficulties physicians face to find the underlying cause, and due to its usually recurrent nature and the fact that it can be refractory to conventional treatment. Some of the mild cases can be treated with topical steroids, which can be combined with non-steroid anti-inflammatory drugs. However, immunomodulators such as methotrexate, tacrolimus, azathioprine, cyclosporine and mycophenolate mofetil together with anti-tumor necrosis factor-α (anti-TNF alpha) monoclonal antibodies such as adalimumab and infliximab, may be required to control the inflammation and the associated ME in refractory cases, or when an underlying disease is present. This review of the literature will focus mostly on the non-infectious UME.

摘要

黄斑水肿(ME)是葡萄膜炎中最常见的视力威胁性并发症。由于复杂的诊断检查以及医生在寻找潜在病因时面临的困难,并且由于其通常具有复发性以及对传统治疗可能难治的特点,葡萄膜炎性黄斑水肿(UME)的诊断和治疗管理可能具有挑战性。一些轻度病例可用局部类固醇治疗,可与非甾体抗炎药联合使用。然而,对于难治性病例或存在基础疾病时,可能需要免疫调节剂,如甲氨蝶呤、他克莫司、硫唑嘌呤、环孢素和霉酚酸酯,以及抗肿瘤坏死因子-α(抗TNFα)单克隆抗体,如阿达木单抗和英夫利昔单抗,以控制炎症和相关的ME。本文献综述将主要关注非感染性UME。

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