Expert opinion on the management and follow-up of uveitis patients during SARS-CoV-2 outbreak

ABSTRACT

Introduction

Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require particular attention because of their theoretical risk of viral infection, in the context of therapeutic immunosuppression.

Areas covered

This collaborative work proposes practical management and follow-up criteria for uveitis patients in the context of the ongoing SARS-CoV-2 pandemic.

Expert opinion

Management should proceed as usual when access to health care possible in patients who do not belong to a group at high risk of severe SARS-CoV-2 infection, and in uncontrolled uveitis cases. In case of reduced access to eye clinics or high risk of SARS-CoV-2 infection, patients’ management should be stratified based on their clinical presentation. In non-severe uveitis cases, the use of systemic steroids should be avoided, and local steroids preferred whenever possible. In uncontrolled situations where there is real risk of permanent visual loss, high-dose intravenous steroids and/or systemic immunosuppressants and/or biotherapies can be administered depending on the severity of eye disease. Immunosuppressive therapy should not be withheld, unless the patient develops SARS-CoV2 infection.

KEYWORDS:

• Uveitis
• immunosuppression
• SARS-CoV-2
• coronavirus
• management
• corticosteroid
• immunosuppressive therapy
• biologics
• intravitreous injection

Article highlights

• New uveitis patients should be managed as standard, according to the diagnosis, and then followed up as frequently as needed, until control of inflammation has been reached.

• In non-severe uveitis cases, the use of systemic steroids should be avoided, and local steroids should be preferred whenever possible.

• In uncontrolled situations where there is real risk of permanent visual loss, high-dose intravenous steroids and/or systemic immunosuppressants and/or biotherapies can be administered depending on the severity of eye disease.

• Immunosuppressive therapy should not be withheld, unless the patient develops SARS-CoV2 infection.

• Immunosuppressed uveitis patients that are tested positive for SARS-CoV-2 should, preferably after consultation with their uveitis expert, transiently suspend immunosuppression until viral symptoms have resolved.

• Intravitreal injections of steroids should not be delayed when access to health care possible, and patients not considered being at high risk of severe SARS-CoV-2 infection.

• In high risk patients, regular intravitreal or subtenon injections of steroids (alone or as add-on therapy) can be postponed in stable uveitis cases.

Declaration of interest

DSS, TSDG have no conflicts of interest. RR, LF, DP, KPV, DT, ST have received travel expenses from Allergan (Abbvie) for participation in the IRC. In addition, RR has received travel expenses from Allergan, honorarium from Novartis and grant support from Fight for Sight. DP received travel expense from Allergan (now Abbvie) and research grant from Bayer. DS reports personal fees from Celgene, grants, personal fees and non-financial support from Abbvie, grants, personal fees and non-financial support from Sanofi Genzyme, grants and personal fees from Roche Chugai, grants, personal fees and non-financial support from Janssen, grants from Amgen, non-financial support from Mylan, grants from Sobi, grants from HifiBio, grants from laxoSmithKline. JA is a co-founder of iVeena Holdings, iVeena Delivery Systems and Inflammasome Therapeutics; he has received consultancy fees from Allergan, Biogen, Boehringer Ingelheim, Immunovant, Janssen, Olix Pharmaceuticals, Retinal Solutions, and Saksin LifeSciences. AL is a consultant for Allergan, Bayer HealthCare, BeyeOnics Surgical, ForSightlabs, Notal Vision, Novartis, Roche. BB is a consultant for Abbvie Allergan, Alimera, Novartis, Santen, Théa. Grant received from Allergan, Bayer, Novartis MDS discloses the following conflicts of interest (C- consultant,  E- employee, P- patent; S- support for research): Preceyes BV: PE, Oxular PLC: E, Oxurion: P, Zeiss, Alcon, Tarsius: S, Allergan, Novartis, Bayer, Charles River Labs, Santen, Tarsius: C. ST received travel grants and consultant fees from Allergan, Novartis and Bayer.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We would like to thank Dr. Alastair Denniston and Andrew Dick for their expertise and critical review of this paper.

Both Dinu Stanescu and Thomas Sales de Gauzy participated equally to this work. On behalf of the International Retina Collaborative (IRC).

Additional information

Funding

This paper was not funded.