眼内中部、后部和全葡萄膜炎的局部治疗:当前的概念和新兴疗法。
Local treatment of infectious and noninfectious intermediate, posterior, and panuveitis: current concepts and emerging therapeutics.
机构信息
Tennessee Retina, Nashville, Tennessee.
Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA.
出版信息
Curr Opin Ophthalmol. 2020 May;31(3):174-184. doi: 10.1097/ICU.0000000000000651.
PURPOSE OF REVIEW
Local therapeutics play an important role in the management of infectious and noninfectious uveitis (NIU) as well as certain masquerade syndromes. This review highlights the established therapeutics and those under investigation for the management of uveitis.
RECENT FINDINGS
An injectable long-acting fluocinolone acetonide insert was recently approved by the Food and Drug Administration for the treatment of NIU affecting the posterior segment. Intravitreal methotrexate, sirolimus, and anti-vascular endothelial growth factor (VEGF) agents are being evaluated for efficacy in NIU. Intravitreal foscarnet and ganciclovir are important adjuncts in the treatment of viral retinitis as are methotrexate and rituximab for the management of vitreoretinal lymphoma.
SUMMARY
Local injectable steroids with greater durability are now available for NIU but comparative efficacy to other treatment modalities remains to be determined. Local steroid-sparing immunosuppressive agents are undergoing evaluation for efficacy in NIU as are anti-VEGF agents for uveitic macular edema. Local antivirals may improve outcomes in cases of viral retinitis. Local chemotherapeutics can help induce remission in vitreoretinal lymphoma.
目的综述
局部治疗在感染性和非感染性葡萄膜炎(NIU)以及某些伪装综合征的治疗中起着重要作用。本综述重点介绍了已确立的治疗方法以及正在研究用于葡萄膜炎治疗的方法。
最近的发现
一种可注射长效氟轻松醋酸酯植入物最近获得美国食品和药物管理局批准,用于治疗影响后节的 NIU。眼内注射甲氨蝶呤、西罗莫司和抗血管内皮生长因子(VEGF)药物正在评估其在 NIU 中的疗效。眼内注射膦甲酸和更昔洛韦是治疗病毒性视网膜炎的重要辅助药物,甲氨蝶呤和利妥昔单抗也是治疗玻璃体内视网膜淋巴瘤的重要药物。
总结
现在有更持久的局部注射类固醇可供 NIU 使用,但与其他治疗方式的比较疗效仍有待确定。局部类固醇保存免疫抑制剂正在评估其在 NIU 中的疗效,抗 VEGF 药物也在评估其对葡萄膜炎性黄斑水肿的疗效。局部抗病毒药物可能改善病毒性视网膜炎的预后。局部化疗可以帮助诱导玻璃体内视网膜淋巴瘤的缓解。