Treatment of uveitis: past, future and present

ABSTRACT

This presentation will review the different treatments of uveitis. The use of corticosteroids, immunosuppressive medications and the upcoming newer modalities for treatment will be reviewed. The discoveries of the different types of immune reactions, the T helper subset functions (Th1 and Th2), the understanding of ACAID (anterior chamber associated immune deviation), the identification of the intraocular immune cell types, and the role of cytokines in the pathogenesis of inflammation, result in a better understanding of autoimmune diseases such as non-infectious uveitis. This improved understanding has allowed the development of new experimental uveitis treatments that may become the standard of care. For example, processing of specific antigens in the gut was demonstrated to induce tolerance by the release of suppressor cytokines like tumour growth factor-B, interleukin (IL)-4 and IL10. Therapeutic approaches like immune modulation with interferon, the use of soluble tumour necrosis factor receptor, anti-Tac, monoclonal antibodies against cell adhesion molecules, and antisense therapies are becoming useful in the treatment of severe uveitis. Intervitreal sustained release devices for the delivery of drugs like corticosteroids, cyclosporins and other immunosuppressive medications will soon become commercially availble. Gene somatic therapy appears another promising therapeutic approach. The use of viral and non viral vectors, and the host immune response against modifies adenoviruses, are solved.(AU)