Oftalʹmologiâ (Jul 2023)
Review of the Effectiveness of Modern Treatment of Non-Infectious Uveitis
Abstract
Uveitis is a term that combines an extensive group of diseases, which are based on inflammation of the choroid of the eyeball. A special place is given to non-infectious uveitis. This group of diseases has an autoimmune origin and the largest proportion of the incidence falls on them. The largest share of morbidity is from this group of uveitis. Despite the successes in modern approaches to the treatment of uveitis, the issue of timely diagnosis and treatment of diseases of the vascular eye membrane does not lose its relevance. The social significance of this pathology is determined by the growing rate of visual acuity decline, the development of complications and early disability. Many studies have revealed a relationship between the untimely late start of treatment and the likelihood of vision loss leading to a deterioration in the quality of life. The therapy of non-infectious uveitis is based on the suppression of the local immune response. Depending on the activity of the inflammatory process, it may include local treatment (instillation of corticosteroids, nonsteroidal anti-inflammatory drugs and mydriatics) and systemic immunosuppression using corticosteroids, alkylating agents (cyclophosphamide, chlorambucil), antimetabolites (azathioprine, methotrexate, mycophenolate mofetil), T-cell inhibitors (cyclosporine and tacrolimus). According to the experience of clinicians, the therapeutic efficacy of steroids even in high doses in treatment of the chronic uveitis provides only partial remission and is associated with the development of serious side effects. Positive results were found when using a combination of steroids with cytostatics, however, with their prolonged use, it is possible to manifest properties such as hepatotoxicity and nephrotoxicity, mutagenicity, carcinogenicity, sterilization, as well as bone marrow suppression, and, as a consequence, the occurrence of severe thrombocytopenic bleeding and granulocytopenic infections. In the case of intermediate, posterior and severe and moderate panuveitis that does not respond to immunosuppressive therapy with methotrexate and cyclosporine A, patients are transferred to therapy with genetically engineered biological drugs (GIBP). The drugs of biological therapy include selective regulators of cytokine levels. The mechanism of their action is based on the selective cytokines’ binding using monoclonal antibodies or soluble cytokine receptors. This article is devoted to evaluating the effectiveness of biological therapy as the drugs of choice.
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