%0 Journal Article
%T Systemic Treatments for Noninfectious Vitreous Inflammation
%A Angela Jiang
%A Jillian Wang
%A Malav Joshi
%A John Byron Christoforidis
%J Mediators of Inflammation
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/515312
%X Vitreous inflammation, or vitritis, may result from many causes, including both infectious and noninfectious, including rheumatologic and autoimmune processes. Vitritis is commonly vision threatening and has serious sequelae. Treatment is frequently challenging, but, today, there are multiple methods of systemic treatment for vitritis. These categories include corticosteroids, antimetabolites, alkylating agents, T-cell inhibitors/calcineurin inhibitors, and biologic agents. These treatment categories were reviewed last year, but, even over the course of just a year, many therapies have made progress, as we have learned more about their indications and efficacy. We discuss here discoveries made over the past year on both existing and new drugs, as well as reviewing mechanisms of action, clinical dosages, specific conditions that are treated, adverse effects, and usual course of treatment for each class of therapy. 1. Introduction Vitreous inflammation, or vitritis, may result from many causes, including both infectious and noninfectious. Epidemiologic studies indicate that uveitis accounts for 2¨C10% of prevalent blindness in the European and North American population and is therefore an underrated and significant public health problem [1]. Infectious etiologies include bacterial Lyme, syphilis, or Bartonella; viruses HSV, VZV, and CMV, and a variety of fungal and parasitic causes. Noninfectious etiologies include rheumatologic and autoimmune processes, examples being sarcoidosis, systemic lupus erythematosus, multiple sclerosis, and Behcet¡¯s disease. However, idiopathic vitritis without associated systemic disease is most common. Vitritis is sometimes visionthreatening, due to sequelae such as cystoid macular edema (CME), vitreous opacities, and retinal detachment, ischemia/neovascularization, or pigment epithelium changes. Glaucoma and cataracts may also form. With such serious sequelae, there are multiple methods of systemic treatment for vitritis. On the other hand, mild vitritis without vasculitis or CME can sometimes be followed closely without any treatment. The goal of all types of treatment is to rapidly alter and stop the course of intraocular inflammation but at the same time minimize any side effects from these systemic drugs. We reviewed these treatment categories last year, but, even over the course of just a year, many therapies have made progress, as we have learned more about their indications and efficacy [2]. 2. Initial Treatment: Corticosteroids The first line of treatment for noninfectious uveitis is corticosteroids. This group of
%U http://www.hindawi.com/journals/mi/2013/515312/