Development of new treatments for uveitis

Research at the UCL Institute of Ophthalmology over the last 15 years has developed new treatments for management of uveitis and its sight-threatening complications, which have subsequently become standard practice.

Uveitis is inflammation of the middle layer of the eye, called the uvea or uveal tract. It is relatively rare, affecting around two to five in every 10,000 people in the UK every year, but nevertheless it is a significant cause of blindness, especially in people of working age.

Over the last 15 years, researchers at the UCL Institute of Ophthalmology led by Professor Sue Lightman have investigated and developed new local and systemic treatments for uveitis. This work has been particularly important in previously untreatable forms of the disease, for example where patients do not respond to steroid therapy, or where they cannot take these drugs due to the side effects. For these patients, Professor Lightman and colleagues demonstrated in 1999 that treatment with mycophenolate mopfetil (MMF) is effective, and may be sight-saving. In other patients, as a result of these treatments, vision has been restored and the dose of systemic steroids reduced or stopped completely. MMF is now the major second-line drug used in management of uveitis.

Cystoid macular oedema is a particularly challenging complication of uveitis and is the most common cause of blindness and visual impairment in chronic uveitis, occurring in up to one third of patients. Professor Lightman's studies have contributed greatly to the present best practice in the management of this condition. Research demonstrated that when systemic and periocular medication have failed, vision can be improved by injecting triamcinolone (TA) directly into the eye. This work stimulated a profusion of further research projects on TA and then to the longer-acting intraocular steroids being developed.

A further complication of uveitis is glaucoma, which develops in up to 20% of patients. Previously, ocular hypotensive prostaglandin analogues had been used successfully in primary open angle glaucoma but there was major concern about their use in uveitis patients. Professor Lightman investigated their use in uveitic glaucoma, showing that they were in fact both effective and safe. This allowed these very effective drops to be brought into the management of uveitic glaucoma and reduced the need for surgery.

Most recently, the team has investigated the visual prognosis of patients with ocular Behçet disease, who have the worst visual prognosis of all patients with uveitis. This work showed that anti-TNF drugs can reduce the risk of visual loss in this patient, and as a result, this new treatment is being introduced worldwide.