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Erschienen in: Clinical and Experimental Medicine 2/2016

28.03.2015 | Review Article

Autoimmune uveitis: clinical, pathogenetic, and therapeutic features

verfasst von: Marcella Prete, Rosanna Dammacco, Maria Celeste Fatone, Vito Racanelli

Erschienen in: Clinical and Experimental Medicine | Ausgabe 2/2016

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Abstract

Autoimmune uveitis (AU), an inflammatory non-infectious process of the vascular layer of the eye, can lead to visual impairment and, in the absence of a timely diagnosis and suitable therapy, can even result in total blindness. The majority of AU cases are idiopathic, whereas fewer than 20 % are associated with systemic diseases. The clinical severity of AU depends on whether the anterior, intermediate, or posterior part of the uvea is involved and may range from almost asymptomatic to rapidly sight-threatening forms. Race, genetic background, and environmental factors can also influence the clinical picture. The pathogenetic mechanism of AU is still poorly defined, given its remarkable heterogeneity and the many discrepancies between experimental and human uveitis. Even so, the onset of AU is thought to be related to an aberrant T cell-mediated immune response, triggered by inflammation and directed against retinal or cross-reactive antigens. B cells may also play a role in uveal antigen presentation and in the subsequent activation of T cells. The management of AU remains a challenge for clinicians, especially because of the paucity of randomized clinical trials that have systematically evaluated the effectiveness of different drugs. In addition to topical treatment, several different therapeutic options are available, although a standardized regimen is thus far lacking. Current guidelines recommend corticosteroids as the first-line therapy for patients with active AU. Immunosuppressive drugs may be subsequently required to treat steroid-resistant AU and for steroid-sparing purposes. The recent introduction of biological agents, such as those targeting tumor necrosis factor-α, is expected to remarkably increase the percentages of responders and to prevent irreversible sight impairment. This paper reviews the clinical features of AU and its crucial pathogenetic targets in relation to the current therapeutic perspectives. Also, the largest clinical trials conducted in the last 12 years for the treatment of AU are summarized and critically discussed.
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Metadaten
Titel
Autoimmune uveitis: clinical, pathogenetic, and therapeutic features
verfasst von
Marcella Prete
Rosanna Dammacco
Maria Celeste Fatone
Vito Racanelli
Publikationsdatum
28.03.2015
Verlag
Springer International Publishing
Erschienen in
Clinical and Experimental Medicine / Ausgabe 2/2016
Print ISSN: 1591-8890
Elektronische ISSN: 1591-9528
DOI
https://doi.org/10.1007/s10238-015-0345-6

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