Immunosuppressive therapy for ocular diseases.
OBJECTIVE
To identify advances in immunosuppressive therapy of ocular diseases since 2007.


RESULTS
The biologics in current use include antitumour necrosis factor-alpha agents (infliximab, etanercept and adalimumab), cytokine receptor antibodies (daclizumab) and interferon-alpha2a. They are effective and comparatively well tolerated options in the treatment of refractory uveitis in both adults and children in the short term, except for etanercept. Daclizumab had a favourable outcome in treating birdshot chorioretinopathy but not in Behcet's disease. The uncertainty of their long-term results, their high costs as well as the necessity for repeated intravenous infusions in the case of infliximab limit their widespread use. Mycophenolate mofetil is another efficacious, fairly well tolerated and less costly immunosuppressant. It has the additional advantage of an oral formulation. T cell inhibitors, cyclosporine and tacrolimus, were found to be useful steroid-sparing drugs in allergic eye disease and dry eyes. A number of studies on less invasive sustained ocular drug delivery systems, including episcleral implants, nanospheres, and cyclodextrin particles, were conducted on animals with encouraging results.


CONCLUSIONS
The armamentarium of immunosuppressive agents is constantly expanding and augurs well for the safe and effective treatment of ocular inflammation.
Jap
Aliza
A
Division of Ophthalmology, Changi General Hospital, Singapore.
Chee
Soon-Phaik
SP
D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000077561:Daclizumab; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D011994:Recombinant Proteins; D014605:Uveitis / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D018124:Receptors, Tumor Necrosis Factor; D011994:Recombinant Proteins; D000069285:Infliximab; D000077561:Daclizumab; D000068879:Adalimumab; D009173:Mycophenolic Acid; D000068800:Etanercept