Definition of Uveitis Refractory to Treatment: A Systematic Review in the Absence of a Consensus

ABSTRACT

Purpose

To evaluate the different definition of refractoriness in uveitis in the literature.

Methods

We systematically searched the literature in order to identify definitions of refractory noninfectious uveitis in adult patients. A search strategy in the databases of MEDLINE and Scopus was used to find articles published between January 2005 and October 2018.

Results

Definitions of corticosteroids-refractoriness were related to two main concepts: persistence of inflammation despite the use of corticosteroid and recurrences above a dosage threshold. In terms of immunomodulatory therapy and biologic agents, we observed a great variety of definitions: persistence of inflammation, number of attacks, side effects or complications, symptoms, and best-corrected visual acuity.

Conclusions

The results of this systematic review demonstrate the current lack of consensus on the definition for refractory uveitis, regardless of the treatment being used and revealed a new terminology based on a comprehensive and operational definition for each specific category of refractoriness.

KEYWORDS:

• Resistant
• refractory
• intractable
• uveitis treatment
• glucocorticoids
• immunomodulatory
• biologics
• consensus
• definition

Supplementary material

Supplemental data for this article can be accessed on the Publisher’s website.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This study was supported by Fondo de Fomento al Desarrollo Científico y Tecnológico (FONDEF) grant No. IT17I0087 (to CU) and National Agency for Research and Development (ANID) grant Fondecyt de Iniciación en Investigación No. 11191215 (to LC).