Intravitreal immunotherapy in non-infectious uveitis: an update

ABSTRACT

Introduction

In the past several years, there have been numerous advances in pharmacotherapeutics for the management of uveitis and other ocular inflammatory diseases, including newer therapeutic agents and ocular drug delivery systems. One of the most attractive modes of drug delivery is the intravitreal route since it has proven to be safe and efficacious and prevents unwanted systemic adverse events related to the agent.

Areas covered

In this review, intravitreal delivery of various pharmacotherapeutic agents for noninfectious uveitis has been described. An extensive review of the literature was performed using specific keywords on the PubMed database to identify clinical studies employing various pharmacotherapeutic agents with intravitreal drug delivery for noninfectious uveitis. The mode of action, safety, efficacy, and tolerability of these drugs have also been elucidated.

Expert opinion

Several agents, including biologic response modifier agents, have been found to be safe and efficacious for various indications of uveitis, such as cystoid macular edema, active uveitis, and other conditions such as retinal vasculitis and vitreous haze. The use of intravitreal biological therapies, especially infliximab, has been fraught with potential safety signals such as photoreceptor toxicity. However, pharmacotherapeutic agents such as corticosteroids and anti-vascular endothelial growth factor agents are now widely used in the clinical management of uveitis and its complications.

KEYWORDS:

• Uveitis
• intravitreal
• biological agents
• immunosuppressive agents
• drug toxicity

Article highlights

• Intravitreal route for anti-inflammatory agents such as corticosteroids and immunosuppressive therapies is an important treatment modality for eyes with uveitis as a standalone or adjuvant treatment.

• Intravitreal use of corticosteroids such as triamcinolone, fluocinolone, and dexamethasone implants has been extensively evaluated for noninfectious uveitis and is a viable strategy, though with certain well-known complications.

• Among the conventional immunosuppressive agents, intravitreal use of methotrexate is popular for conditions such as noninfectious uveitis, vitreoretinal lymphoma, and other conditions such as tubercular uveitis.

• Biological response modifying agents such as infliximab and adalimumab are not employed commonly by the intravitreal route due to fears of toxicity and side-effects.

• In the future, there is a scope for the development of agents that can be injected intravitreally for the treatment of uveitis minimizing the risks of cataract formation, rise in intraocular pressure, and infections.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants, or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.