https://orcid.org/0000-0002-2703-0977
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ABSTRACT
Infectious uveitis is a major global cause of vision impairment. Despite the eye’s immune privilege, afforded by the blood-ocular barrier that restricts microbial entry, several pathogens such as bacteria, viruses, fungi, and parasites can still infiltrate and cause ocular infections and complications. Clinicians often encounter significant challenges in treating infectious uveitis due to limited or ineffective treatment options. Modern molecular techniques and imaging can aid in diagnosing and assessing intraocular infections. Various antimicrobial therapies exist, spanning topical and systemic treatments, but these are constrained by issues like drug concentration, penetration, effective duration, toxicity, and side effects. Treatment approaches also differ based on the infection’s etiology. This review provides recent updates on antimicrobial therapies from a clinical perspective, covering topical, systemic, and regional treatments for infectious uveitis.
Abbreviations
| AIDS | = | Acquired immune deficiency syndrome |
| AIM2 | = | Absent in melanoma 2 |
| AMD | = | Age related macular degeneration |
| ARN | = | Acute retinal necrosis |
| ASC | = | Apoptosis speck-like protein |
| ATT | = | Anti-tubercular therapy |
| AU | = | Anterior Uveitis |
| BE | = | Bacterial endophthalmitis |
| CMV | = | Cytomegalovirus Infection |
| COTS | = | Collaborative Ocular Tuberculosis Study |
| HAART | = | Highly active antiretroviral therapy |
| HIV | = | Human immunodeficiency virus |
| HSV | = | Herpes Simplex Virus |
| IL-1β | = | Interleukin-1β |
| IL-18 | = | Interleukin-18 |
| IOP | = | Intraocular pressure |
| IRU | = | Immune reconstitution uveitis |
| IV | = | Intravenous |
| JHR | = | Jarisch-Herxheimer reaction |
| MTU | = | Mycobacterial uveitis |
| NLRC4 | = | NLR family pyrin domain containing 4 |
| NLRP1 | = | NLR family pyrin domain containing 1 |
| NLRP3 | = | NOD-LRR-and pyrin domain-containing protein 3 |
| NNHR | = | Non-necrotising herpetic retinitis |
| OT | = | Ocular Tuberculosis |
| PORN | = | Progressive outer retinal necrosis |
| RCT | = | Randomized control trial |
| VEGF | = | Vascular endothelial growth factor |
| VZV | = | Varicella Zoster Virus |
Author contributions
Study conception anddesign: EL, RPS, RA; data collection and review: EL, RPS, CCG, WRC; preliminary draft manuscript preparation: EL, RPS; draft corrections: CCG, WRC, final manuscript writing: CCG, EL; figure(s) preparation: WRC; intelectual inputs: JH, MK, IP, ADLT. All authors reviewed and approved the final version of the manuscript.
Acknowledgments
Authors gratefully acknowledge the funding agency “National Medical Research Council of Singapore (NMRC), or MOE, and other clinicians awarded a research grant to Prof. Rupesh Agrawal, Senior Consultant, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore.
Disclosure statement
No potential conflict of interest was reported by the author(s).