Rodrigo A Valenzuela1,2, Iván Flores1, Myriam Pujol1, Carolina Llanos3, Ester Carreño4, Gabriel Rada5, Carl P Herbort6,7, Loreto Cuitino1,8, Cristhian A Urzua1,9,10. 1. Laboratory of Ocular and Systemic Autoimmune Diseases, Faculty of Medicine, University of Chile, Santiago, Chile. 2. Departamento de Ciencias Químicas y Biológicas, Facultad de Salud, Universidad Bernardo O'Higgins, Santiago, Chile. 3. Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile. 4. Fundación Jiménez Díaz, University Hospital, Madrid, Spain. 5. Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 6. Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland. 7. Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Lausanne, Switzerland. 8. Servicio de Oftalmología, Hospital Clínico Universidad de Chile, Santiago, Chile. 9. Department of Ophthalmology, Faculty of Medicine, University of Chile, Santiago, Chile. 10. Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Abstract
PURPOSE: To evaluate the different definition of refractoriness in uveitis in the literature. METHODS: We systematically searched the literature in order to identify definitions of refractory noninfectious uveitis in adult patients. A search strategy in the databases of MEDLINE and Scopus was used to find articles published between January 2005 and October 2018. RESULTS: Definitions of corticosteroids-refractoriness were related to two main concepts: persistence of inflammation despite the use of corticosteroid and recurrences above a dosage threshold. In terms of immunomodulatory therapy and biologic agents, we observed a great variety of definitions: persistence of inflammation, number of attacks, side effects or complications, symptoms, and best-corrected visual acuity. CONCLUSIONS: The results of this systematic review demonstrate the current lack of consensus on the definition for refractory uveitis, regardless of the treatment being used and revealed a new terminology based on a comprehensive and operational definition for each specific category of refractoriness.
PURPOSE: To evaluate the different definition of refractoriness in uveitis in the literature. METHODS: We systematically searched the literature in order to identify definitions of refractory noninfectious uveitis in adult patients. A search strategy in the databases of MEDLINE and Scopus was used to find articles published between January 2005 and October 2018. RESULTS: Definitions of corticosteroids-refractoriness were related to two main concepts: persistence of inflammation despite the use of corticosteroid and recurrences above a dosage threshold. In terms of immunomodulatory therapy and biologic agents, we observed a great variety of definitions: persistence of inflammation, number of attacks, side effects or complications, symptoms, and best-corrected visual acuity. CONCLUSIONS: The results of this systematic review demonstrate the current lack of consensus on the definition for refractory uveitis, regardless of the treatment being used and revealed a new terminology based on a comprehensive and operational definition for each specific category of refractoriness.