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Purpose: To compare the evidence base and systemic treatment strategies for sarcoidosis. Methods: Medline and EMBASE literature search on ''sarcoidosis AND treatment'', ''sarcoidosis AND uveitis AND treatment'', and ''sarcoidosis AND eye AND treatment''. The search was limited to randomized controlled trials (RCTs) and meta-analyses. Results: A total of 19 RCTs for the systemic treatment of extraocular sarcoidosis were identified. The majority were on corticosteroid--oral and inhaled. There were two meta-analyses on corticosteroid, including a Cochrane review. Only two RCTs were indentified for the treatment of intraocular sarcoidosis, one on etanercept, and the other from 1967 on prednisolone or oxyphenbutazone vs. placebo. There were no meta-analyses. Due to the paucity of RCTs other treatment studies were included but these were limited to only a few immunosuppressive agents and on small numbers of patients. Conclusion: Limited high-quality evidence exists for the systemic treatment of sarcoidosis, in particular intraocular disease. [ABSTRACT FROM AUTHOR]

Ocular involvement in Behçet disease (BD) is characterized by recurrent inflammatory attacks and spontaneous resolution of acute inflammatory signs. Both frequency and severity of uveitis attacks determine the magnitude of irreversible damage to intraocular structures and long-term visual prognosis. Recurrent attacks of occlusive retinal vasculitis lead to vision-threatening complications such as cystoid macular edema, retinal neovascularization, optic atrophy and retinal atrophy. This manuscript updates about the role of various drugs in the management of BD, discussing corticosteroids, disease modifying immunosuppressive drugs, and finally biologicals (anti-TNF-blocking agents and alpha interferon) which seem to be superior compared to all other available drugs in preventing loss of vision. Also recent findings from new biologicals will be summarized, and especially the role of these drugs in children will be discussed in detail. The authors suggest that at least moderate to severe retinal involvement should become treated with biologicals whenever available. [ABSTRACT FROM AUTHOR]

Uveitis maybe induced by the use of various medications known as drug-induced uveitis (DIU), though rare it is an important cause of uveitis which one needs to be aware of. The drugs may be administered through any route including systemic, topical, and intravitreal. Ocular inflammation can be in the form of anterior, intermediate, posterior or pan uveitis, and rarely may present as episcleritis and scleritis. Identification of drug as the offending agent of uveitis is important as many a times stopping the drug may help recover the uveitis or the concomitant use of corticosteroids. An extensive literature review was done using the Pubmed. An overview of DIU is provided as it is important for us to be aware of this clinical entity. [ABSTRACT FROM AUTHOR]

To evaluate the duration of immunomodulatory therapy (corticosteroids, immunosuppressive drugs) with regard to the rate of relapses and clinical features (exudative retinal detachment or anterior uveitis) in inflammatory episodes of Vogt-Koyanagi-Harada disease. Data of all 42 patients diagnosed with acute uveitis associated with VKH disease during the period of January 2005 to December 2008 at the Pitié-Salpêtrière Hospital or at the Lariboisière Hospital in Paris, France were extracted by chart review. There were 31 patients (73.8%) with episodes of recurrence and were included in the study. At the first recurrence, 81% (13 patients) of exudative retinal detachments (ERD) were associated with an initial immunomodulatory treatment conducted ≤6 months (3.76 months ± 2.67). Conversely, an initial treatment duration of >6 months was associated with anterior uveitis signs for 66% of patients (eight patients) with anterior first recurrence (p = 0.0061). On second episode of recurrence, 75% of patients (three patients) who developed exudative retinal detachment had been managed by immunomodulatory therapy for ≤6 months with the total duration of immunomodulatory treatment ≤6 months during previous inflammatory episodes. Conversely, all 16 patients who presented anterior uveitis with additional manifestations (optic disc oedema, macular oedema, vitritis and/or 'Sunset glow' fundus) have been treated for more than 6 months or treated during the initial occurrence lasting more than 9 months (p = 0.0035). The duration of systemic corticosteroids (and/or immunosuppressive drug therapy) for ≤6 months at first and second recurrence was associated with features of further exudative retinal detachment instead of anterior uveitis in VKH disease. [ABSTRACT FROM AUTHOR]

Purpose: Corticosteroids (CS) are the only approved drug class for treatment of noninfectious uveitis by the U.S. Food and Drug Administration. Serious side effects are associated with chronic use of systemic CS; established guidelines recommend the use of steroid-sparing agents if control of uveitis cannot be achieved with ≤10 mg/day of prednisone (or equivalent) within 3 months. This study evaluated the treatment patterns among physicians who routinely manage patients with noninfectious uveitis to determine how treatment guidelines are followed. Design: Cross-sectional, multicenter study conducted across the United States. Participants: Sixty ophthalmologists and 3 rheumatologists were recruited using payer reimbursement International Classification of Diseases, Ninth Revision codes. Methods: Patient data were reported using a study-specific questionnaire. Physicians were also asked if they were aware of or used recommended treatment guidelines. Main Outcome Measures: Uveitis treatment patterns were compared with guidelines. Results: Physicians managed a mean of 5555 patients; patients with uveitis who required systemic CS treatment comprised approximately 5% of each physician''s practice. A total of 580 patients with noninfectious uveitis were randomly selected for analyses. Anterior uveitis requiring systemic therapy was diagnosed in 168 patients (29%), intermediate uveitis was diagnosed in 140 patients (24%), posterior uveitis was diagnosed in 150 patients (26%), and panuveitis was diagnosed in 122 patients (21%); 199 patients (34%) had active disease. The mean time interval from the diagnosis of uveitis to the time of survey was 3.1 to 4.5 years. A systemic disorder was associated with uveitis in 16% to 54% of patients; 57% to 100% of patients received systemic immunosuppressive therapy. In all, 360 of 580 patients (62%) received systemic CS, with a mean initial daily dose of 44 mg, tapered to 34 mg prednisone (or equivalent) as maintenance dose. Among physicians surveyed, 75% did not use or were not aware of treatment guidelines for uveitis. Conclusions: The study reveals that the majority of physicians surveyed are not familiar with or do not adhere to currently recommended guidelines for management of uveitis. High CS doses are used to maintain control of disease, and there is a low level of awareness of recommended guidelines to treat noninfectious uveitis. The finding underscores the need to place further emphasis on educating the medical community and reinforcing treatment guidelines to improve the care of patients with uveitis. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To investigate long-term responsiveness of patients with severe uveitis associated with Behçet disease to interferon alpha2a (IFN-alpha2a).Design: Retrospective study.Methods: Thirty-two patients with sight-threatening uveitis associated with Behçet disease who relapsed despite corticosteroids and immunosuppressive agents were included. IFN-alpha2a was administered subcutaneously (three million units thrice a week). Ophthalmologic examination and fluorescein angiography associated with laboratory tests were performed at regular intervals. Main outcome measures were visual acuity and recurrence of uveitis attacks before, during, and after initiation of IFN-alpha2a therapy.Results: Control of inflammation was achieved in 28 of 32 patients (88%). Mean observation period of the 28 responder patients was 70.6 months (range, 30.3 to 129.2 months). Median visual acuity improved from 0.52 to 0.33 (logarithm of the minimum angle of resolution units; P = .005) two years after initiation of IFN-alpha2a therapy. The relapse rate decreased significantly during IFN-alpha2a treatment from 1.68 +/- 1.22 relapses/patient/year to 0.11 +/- 0.20 relapses/patient/year (P < .0001). IFN-alpha2a was discontinued in 19 of 28 patients (68%) after 32 months of treatment (range, 16 to 50 months). Mean follow-up after IFN-alpha2a discontinuation was 43 months (range, 11 to 84 months). After IFN-alpha2a discontinuation, the relapse rate increased from 0.08 +/- 0.21 relapse/person/year to 0.74 +/- 1.40 relapse/person/year (P = 0.04).Conclusions: IFN-alpha2a is efficient and safe for the long-term management of severe uveitis associated with Behçet disease. Meanwhile it seems to be a suspensive therapeutic strategy, even though long-term remission is possible in some patients. [ABSTRACT FROM AUTHOR]

Purpose: To report the value of endoretinal biopsy in establishing the diagnosis of severe posterior uveitis. Methods: A clinicopathologic report of three patients with severe posterior uveitis unresponsive to corticosteroids and with a negative systemic workup. These patients subsequently underwent vitrectomy and endoretinal biopsy. Results: Endoretinal biopsy provided an accurate diagnosis in the three cases, leading to appropriate treatment. Histopathologic examination of the three retinal samples confirmed the diagnosis of sarcoidosis, tuberculosis, and lymphoma. Targeted treatment improved the ocular conditions in all three cases. Conclusions: In selected cases of severe bilateral vision-threatening uveitis, retinal biopsy may be indicated as a last resort to confirm a suspected diagnosis of infectious disease or malignancy. [ABSTRACT FROM AUTHOR]