Pharmacotherapy for non-infectious uveitis: spotlight on phase III clinical trials of locally injected or implanted therapeutics and systemic immunomodulatory drugs.

Background: Non-infectious uveitis is an uncommon eye condition, but an important cause of substantial vision impairment and blindness around the world. An individualized treatment approach may include corticosteroids, conventional immunomodulatory medications, and biologic immunomodulatory agents, delivered locally to the eye or by systemic routes.

Body: In this narrative review, we describe pivotal phase III clinical trials that have provided the information guiding clinical practice in non-infectious uveitis today, focusing on studies of injected or surgically positioned local therapeutics, systemic immunomodulatory drugs, and the combination of both.

The Rate of Failure of Trabeculectomy and Tube Shunt Surgery in Eyes with Uveitic Glaucoma and Ocular Hypertension.

Purpose: To evaluate the incidence of failure of trabeculectomy versus tube shunt (TS) glaucoma surgery in eyes of patients with uveitis.

Design: Multicenter retrospective cohort study.

Participants: Among 356 eyes of 288 patients with noninfectious inflammatory eye disease undergoing first incisional glaucoma surgery using one of the techniques, 244 eyes had TSs, and 112 eyes had trabeculectomy augmented with mitomycin-C (Trab-MMC).

Prevalence, Treatment Patterns, and Outcomes of Pediatric Noninfectious Uveitis in the United States: An IRIS Registry Analysis.

Purpose: To describe the prevalence, characteristics, and treatment patterns of pediatric noninfectious uveitis in the United States.

Design: Retrospective database study.

Subjects: Patients with noninfectious uveitis diagnosed and treated at age ≤18 years with ≥1 year follow-up identified in the IRIS® (Intelligent Research in Sight) Registry between January 1, 2013, and December 31, 2019.

Effectiveness of Frequently Used TNF Inhibitors vs. Conventional Immunosuppressive Therapies for Noninfectious Uveitis.

Purpose: To compare the corticosteroid sparing efficacy of frequently used antimetabolites to tumor necrosis factor (TNF) inhibitors in the management of noninfectious ocular inflammation.

Methods: Retrospective analysis of patients with noninfectious uveitis on conventional antimetabolite (methotrexate, mycophenolate mofetil, azathioprine,or leflunomide, "CONV") or a TNF inhibitor (adalimumab or infliximab, "TNFi") with active inflammation or more than 7.5 mg daily prednisone.

Electroretinography of disease activity and treatment response in birdshot chorioretinopathy.

Purpose: To identify full-field electroretinographic (ffERG) biomarkers that differentiate active versus inactive birdshot chorioretinopathy (BSCR) and long-term efficacy of intravitreal versus systemic immunosuppression.

Methods: Patients with BSCR at Casey Eye Institute with ffERG between 1999-2019 were included (n = 29). A group of healthy patients was used as controls (n = 47).

Incidence and Outcome of Cataract in Eyes with Scleritis and Episcleritis.

Purpose: To estimate the incidence and predictive factors for cataract in eyes with episcleritis and scleritis, and to evaluate the outcome of cataract surgery in those eyes.

Design: Retrospective cohort study at uveitis subspecialty centers.

Methods: One thousand three hundred eighty-four eyes with non-infectious scleritis and episcleritis at risk of cataract were included.

Incidence and Outcomes of Cataract in Eyes with Ocular Cicatricial Pemphigoid.

Purpose: To identify the incidence of cataract and the outcomes of cataract surgery in eyes with ocular cicatricial pemphigoid (OCP).

Methods: Phakic eyes were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study and followed for the incidence of visually significant cataract defined as: newly reduced visual acuity 20/50 or worse attributed to cataract; and/or incident cataract surgery. Secondarily, all eyes with OCP that underwent cataract surgery and had a year of follow up thereafter, were included in an analysis of visual outcome.

Vitamin D Supplementation and Remission from Chronic Anterior Uveitis.

Purpose: Chronic anterior uveitis (CAU) often requires suppressive therapy, which has potential side effects including cataract, ocular hypertension, and increased risk of infection. No remittive therapy is currently available; however, several studies have demonstrated an association between low 25-hydroxy Vitamin D (25OHD) levels and either uveitis incidence or uveitis disease activity. This study investigates the potential of Vitamin D supplementation as a remittive treatment for CAU.

Association Between Baseline Macular Morphologic Features on Optical Coherence Tomography and Visual Outcomes in Patients with Vogt-Koyanagi-Harada Disease.

Purpose: The choroidal thickening and serous retinal detachments that characterize Vogt-Koyanagi-Harada (VKH) disease can be imaged in detail using spectral domain optical coherence tomography (SD-OCT). Whether specific qualitative and quantitative SD-OCT features at presentation were associated with visual outcomes in a randomized controlled trial comparing methotrexate to mycophenolate for steroid-sparing control of uveitis were evaluated.

Methods: An exploratory subanalysis of data from the FAST trial in which SD-OCT images from VKH participants were analyzed for presence/absence of bacillary detachments, retinal pigment epithelium (RPE) folds, and internal limiting membrane (ILM) fluctuations was performed.

Outcomes in Patients With Vogt-Koyanagi-Harada Disease From the First-Line Antimetabolites for Steroid-Sparing Treatment Uveitis Trial.

Purpose: To compare the effectiveness of methotrexate (MTX) and mycophenolate mofetil (MMF) in achieving corticosteroid-sparing control of uveitis in patients with Vogt-Koyanagi-Harada (VKH) disease.

Methods: A subanalysis of patients with VKH from the First-line Antimetabolites as Steroid-sparing Treatment Uveitis Trial, a randomized, observer-masked, comparative effectiveness trial, with comparisons by treatment (MTX vs MMF) and disease stage (acute vs chronic). Individuals with noninfectious uveitis were placed on a standardized corticosteroid taper and block randomized 1:1 to either 25 mg weekly oral MTX or 1.

Incidence and Remission of Post-Surgical Cystoid Macular Edema Following Cataract Surgery in Eyes With Intraocular Inflammation.

Purpose: To evaluate the incidence, remission, and relapse of post-surgical cystoid macular edema (PCME) following cataract surgery in inflammatory eye disease.

Methods: A total of 1859 eyes that had no visually significant macular edema prior to cataract surgery while under tertiary uveitis management were included. Standardized retrospective chart review was used to gather clinical data.

LATE DIAGNOSIS OF Cutibacterium acnes (FORMERLY Propionibacterium acnes ) ENDOPHTHALMITIS AND THE IMPORTANCE OF DUAL TESTING WITH BACTERIAL CULTURE AND POLYMERASE CHAIN REACTION.

Purpose: The purpose of this study was to describe two cases of Cutibacterium acnes endophthalmitis that reinforce the importance of performing both bacterial culture and 16S polymerase chain reaction when the causative pathogen is unclear or difficult to culture, such as C. acnes . A case of C.

-associated retinitis successfully treated with intravitreal and systemic antimicrobials.

Purpose: To describe a case of unilateral -associated retinitis in the absence of concomitant corneal infection in an immunocompetent host without risk factors.

Observations: A 37-year-old woman presented with unilateral multifocal retinitis with minimal vitritis. Anterior segment was normal.

Use of immunosuppression and subsequent cancer incidence: cohort study.

Objective: Evaluate the association between cancer incidence and immunosuppressive treatment in patients with ocular inflammatory disease (OID).

Methods And Analysis: We performed a retrospective cohort study of patients from 10 US OID subspecialty practices. Patients with non-infectious OID were included; HIV-infected patients were excluded.

Characterization of autoimmune eye disease in association with Down's syndrome.

Background: Autoimmunity and deficiency of the transcription factor autoimmune regulator protein (AIRE) are known associations with Down syndrome (DS). Lack of AIRE abrogates thymic tolerance. The autoimmune eye disease associated with DS has not been characterized.

Incidence of and Risk Factors for Cataract in Anterior Uveitis.

Purpose: To estimate the incidence/risk factors for cataract in noninfectious anterior uveitis.

Design: Retrospective multicenter cohort study (6 US tertiary uveitis sites, 1978-2010).

Methods: Data were harvested by trained expert reviewers, using protocol-driven review of experts' charts.

Risk of failing both methotrexate and mycophenolate mofetil from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial.

Background: The antimetabolites methotrexate (MTX) and mycophenolate mofetil (MMF) are commonly used as initial corticosteroid-sparing treatment for uveitis. There is little data examining risk factors for failing both MTX and MMF. The objective of this study is to determine risk factors for failing both MTX and MMF in patients with non-infectious uveitis.

Risk Factors Associated with Unexpected Refractive Outcomes in Uveitic Cataract Surgery.

Objective: Assess refractive outcomes following uveitic cataract surgery and identify factors associated with deviations from the target refractive goal.

Methods: A multicenter retrospective chart review was performed for 216 subjects with uveitis undergoing cataract surgery. Prediction error was calculated and tested for association with demographic and clinical characteristics using single variable and multiple regression analysis.

Association between Quality of Life and Visual Acuity in a Randomized Clinical Trial of Patients with Uveitis Taking Antimetabolites.

Purpose: To evaluate how changes in visual acuity are associated with changes in quality of life (QoL) among patients with non-infectious uveitis taking antimetabolites.

Methods: This secondary analysis of the multicenter First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial involves 216 participants randomized to methotrexate or mycophenolate mofetil. Vision-related (NEI-VFQ and IND-VFQ) and health-related (PCS and MCS SF-36v2) QoL and visual acuity were measured at baseline and 6-month primary endpoint.

Reduced Dose Methotrexate and Mycophenolate Mofetil in Noninfectious Uveitis: A Sub-Analysis from the First-Line Antimetabolites as Steroid Sparing Therapy (FAST) Trial.

Purpose: Some patients taking methotrexate (MTX) or mycophenolate mofetil (MMF) experience intolerable side effects at full doses. We evaluated whether dose reduction affected treatment outcomes in uveitis patients.

Methods: Subanalysis of the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial.