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What's New in Uveitis and Ocular Inflammation?

Uveitis and intraocular inflammation are important sight-threatening disorders worldwide, and it has been estimated that uveitis is responsible for around 5% to 10% of blindness in the United States and various Western countries. If the uveitis is not treated optimally, visual loss can develop because of various sight-threatening complications including band keratopathy, cataract, glaucoma, cystoid macular edema, retinal scars, and optic neuropathy. Among the working age group of 20 to 65 years, uveitis is second only to diabetic retinopathy as a major cause of treatable blindness. Therefore, uveitis is an ocular disease that carries a high socioeconomic impact. Recent advancements in both basic science and clinical research have greatly enhanced our understanding in the pathogenesis, etiology, and management of uveitis and ocular inflammatory diseases. In this issue of the Asia Pacific Journal of Ophthalmology, Kedhar provided an excellent literature review in research and development on ocular immunology and uveitis published in 2011 to 2012. This review gives a very comprehensive snapshot of ‘‘what’s new in uveitis’’ and summarized important findings from various studies including the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) study and the Multicenter Uveitis Steroid Treatment (MUST) trial. Both SITE and MUST studies were sponsored by the National Eye Institute, and the results provided important supportive evidence to improve the management of uveitis and our understanding in the risk factors and prognosis of uveitis. In addition to the research topics covered in the review by Kedhar, there are 3 other areas in uveitis with articles published in 2011Y2012 that might be of interest to clinicians. These include genetic studies on uveitis, the use of antiangiogenesis therapy for inflammatory ocular neovascularization, and newer biologic agents for treating uveitis. Over the past few years, a number of studies have been performed to evaluate the association of various genes involved in the immunological system in uveitis. One of these genetic factors is the complement factor H (CFH) gene, which is a key regulator in the alternative complement pathway of the immune system. The CFH 184G polymorphism has been found to be associated with anterior uveitis, and this association was specific for females. Moreover, the CFH I62V polymorphism was also found to be associated with noninfectious intermediate and posterior uveitis. These CFH variants might result in structural changes in the CFH protein and can affect the affinity of C3b binding, which subsequently influence the activation of the alternative pathway. Polymorphism in the complement factor B (CFB) gene, an opponent of CFH, has also been found to be associated with anterior uveitis. In addition, several studies have also shown that polymorphisms in interleukin and cytokine genes were associated with uveitis and Behçet disease. These studies have enhanced our understanding in the role of genetics in the pathogenesis of uveitis and might provide future potential target for the treatment of intraocular inflammation. Another important recent development in the management of ocular comorbidity associated with uveitis is the availability of antiYvascular endothelial growth factor (VEGF) agents such as intravitreal bevacizumab and ranibizumab for choroidal neovascularization (CNV) secondary to ocular inflammation. At present, the use of anti-VEGF agents in CNV secondary to ocular inflammation is considered as off-labeled use. Nonetheless, published studies have demonstrated beneficial visual outcomes following anti-VEGF therapy for inflammatory CNV. In particular, the long-term outcome with up to 5 years of follow-up was favorable with no major complication encountered. Therefore, it is reasonable to consider anti-VEGF therapy as the standard therapy for CNV due to ocular inflammation. An area of research deficiency highlighted in Kedhar’s review is the paucity of large-scale randomized controlled trials for uveitis treatment published in 2011Y2012. Nonetheless, large-scale EDITORIAL