Uveitis
Uveitis is a term that encompasses a heterogeneous group of intraocular inflammatory diseases primarily affecting the uveal tract, which includes the iris, ciliary body, and choroid, but it may also involve adjacent ocular structures such as the retina, vitreous, and optic nerve. The pathogenesis of uveitis is multifactorial and can arise from infectious agents, immune-mediated mechanisms, or as a manifestation of systemic autoimmune diseases. In many cases, the etiology remains idiopathic. Inflammatory processes within the uveal tract result in disruption of the blood-ocular barrier, recruitment of immune cells, and release of cytokines and other inflammatory mediators, leading to tissue damage and potential vision loss. Uveitis is a significant cause of visual morbidity worldwide, accounting for approximately 10-15% of cases of legal blindness in developed countries. The disease can be acute or chronic, and its health impacts range from mild discomfort and reversible vision changes to irreversible complications such as cataract, glaucoma, macular edema, retinal detachment, and permanent visual impairment.
Anterior uveitis, also referred to as iritis or iridocyclitis, is the most common form of uveitis and involves inflammation of the anterior segment of the uvea, primarily affecting the iris and anterior part of the ciliary body. It is characterized clinically by ocular pain, redness, photophobia, and decreased vision. Slit-lamp examination typically reveals cells and flare in the anterior chamber, and complications may include posterior synechiae, secondary glaucoma, and cataract formation. Anterior uveitis may be associated with systemic conditions such as HLA-B27-related spondyloarthropathies, juvenile idiopathic arthritis, and sarcoidosis.
Intermediate uveitis primarily affects the vitreous and the peripheral retina, particularly the pars plana region of the ciliary body. The condition is sometimes termed pars planitis when idiopathic. Patients may present with floaters and mild visual blurring, while pain and redness are usually minimal or absent. On examination, vitreous cells and haze are prominent findings, and snowbanking or snowball opacities may be observed in the peripheral retina. Intermediate uveitis may be idiopathic or associated with systemic diseases such as multiple sclerosis and sarcoidosis.
Posterior uveitis involves inflammation of the choroid, retina, or both, and is often more severe in terms of visual prognosis. Clinical manifestations include decreased vision, floaters, and sometimes scotomas. Fundoscopic examination may reveal retinal or choroidal lesions, vasculitis, and macular edema. Posterior uveitis can be caused by infectious agents such as toxoplasma gondii, cytomegalovirus, or non-infectious immune-mediated mechanisms, and is frequently associated with systemic diseases like Behçet's disease and Vogt-Koyanagi-Harada syndrome.
Panuveitis refers to inflammation involving all segments of the uveal tract—anterior, intermediate, and posterior—as well as adjacent ocular tissues. Patients often present with severe visual impairment, pain, redness, and photophobia. Examination reveals widespread intraocular inflammation, with cells and flare in the anterior chamber, vitreous haze, and retinal or choroidal involvement. Panuveitis can be idiopathic or associated with systemic diseases such as sarcoidosis, tuberculosis, or syphilis, and carries a high risk of vision-threatening complications.
The epidemiology of uveitis varies globally, with an estimated annual incidence ranging from 17 to 52 cases per 100,000 person-years and a prevalence of approximately 38 to 115 cases per 100,000 population. Uveitis is more commonly diagnosed in adults between the ages of 20 and 50, although certain types such as juvenile idiopathic arthritis-associated uveitis predominantly affect children. There is no significant gender predilection overall, but specific subtypes may show a gender bias. The distribution of uveitis types also varies by region; anterior uveitis is most common in Western populations, whereas infectious posterior uveitis is more prevalent in developing countries. Uveitis accounts for up to 10-15% of cases of blindness in developed nations and remains a leading cause of visual disability worldwide. Risk factors include genetic predisposition, particularly HLA-B27 positivity, a history of autoimmune disease, and exposure to infectious agents in endemic areas.
The diagnosis of uveitis is based on a comprehensive clinical evaluation, which includes a detailed medical and ocular history, thorough ophthalmic examination, and targeted laboratory investigations. Slit-lamp biomicroscopy is fundamental for detecting anterior chamber cells and flare, keratic precipitates, and iris changes. Indirect ophthalmoscopy and fundus examination are essential for assessing vitreous inflammation, retinal and choroidal involvement, and optic nerve status. Ancillary imaging modalities such as optical coherence tomography (OCT) are used to evaluate macular edema and retinal architecture, while fluorescein and indocyanine green angiography help identify retinal vasculitis and choroidal lesions. Ultrasound B-scan may be necessary in cases with media opacity. Laboratory workup is guided by clinical suspicion and may include complete blood count, erythrocyte sedimentation rate, C-reactive protein, autoimmune markers (e.g., ANA, HLA-B27), serology for infectious agents (e.g., syphilis, tuberculosis, toxoplasmosis), and chest radiography or advanced imaging for systemic disease. Diagnostic criteria rely on the anatomic classification of uveitis, identification of underlying etiologies, and exclusion of masquerade syndromes such as intraocular lymphoma. In refractory or atypical cases, aqueous or vitreous sampling for cytology, PCR, or culture may be indicated.
Adalimumab is a fully human monoclonal antibody that targets tumor necrosis factor-alpha (TNF-α) and is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adults and children; its various biosimilar formulations, including adalimumab-aaty, adalimumab-bwwd, adalimumab-adaz, adalimumab-atto, and adalimumab-fkjp, provide additional therapeutic options with comparable efficacy and safety profiles for patients requiring TNF-α inhibition. Dexamethasone intravitreal implant is a corticosteroid device designed for intraocular delivery, offering sustained anti-inflammatory effects for the management of non-infectious uveitis affecting the posterior segment of the eye. Ciclosporin, also known as cyclosporin or cyclosporine A, is an immunosuppressive agent that acts by inhibiting calcineurin and T-cell activation, and is used systemically or topically to control ocular inflammation in cases of refractory or sight-threatening uveitis. Fluocinolone acetonide, available as an intravitreal implant, is a corticosteroid that provides long-term local immunosuppression and is utilized to treat chronic non-infectious uveitis affecting the posterior segment, reducing the frequency of recurrences and preserving visual function.
| Structure | Generic Name | CAS Registry Number | Molecular Formula | Molecular Weight |
|---|---|---|---|---|
| adalimumab | ||||
| adalimumab; adalimumab-aaty | ||||
| adalimumab; adalimumab-bwwd | ||||
| adalimumab; adalimumab-adaz | ||||
| adalimumab; adalimumab-atto | ||||
| adalimumab; adalimumab-fkjp | ||||
| dexamethasone intravitreal implant | ||||
| adalimumab (Rec INN; USAN) | 331731-18-1 | |||
 | ciclosporin (Rec INN); cyclosporin; cyclosporin A; cyclosporine; cyclosporine A | 59865-13-3 | C62 H111 N11 O12 | 1202.611 |
 | fluocinolone acetonide (Rec INN; USAN; BAN; JAN); sinalar; synandone | 67-73-2 | C24 H30 F2 O6 | 452.488 |
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