الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Uveitis is a potentially sight-threatening ocular condition which accounts for 10-20% of the cases of blindness worldwide. During uveitis treatment, we have to consider its etiology, severity, extent and the associated complications. New therapeutic strategies have been proposed either to suppress the inflammation in non-infectious uveitis or to treat the causative agents in infectious diseases. The aim of this study was to evaluate the efficacy of two new modalities in uveitis treatment: the efficacy of antiparasitic medication in trematode-induced uveitis (part 1) and the efficacy of biologics in non infectious uveitis (part 2). Part 1: A newly identified etiology for uveitis caused by trematodal infection is now emerging especially in rural areas where children are used to swimming in local ponds. Unfortunately, most of these cases are unresponsive to local or systemic corticosteroids. This encouraged us to change our mind and start a course of systemic broad spectrum antiparasitic treatment (praziquantel). A total of 30 cases were included in this part with a mean age of 13.4±2.4 years and all of them were male. Our results revealed positive bilharziasis titre in all patients. After 2 weeks of medical treatment, all cases shows improvement in terms of AC activity. However, in terms of granuloma size those with granuloma <2.5 mm2 (group A) showed reduction 50% of their size, while those ≥ 2.5 mm2 (group B) revealed a reduction 50% of their size. After 4 weeks, the granuloma size in group B remained nearly the same and surgical aspiration was done with immediate dissolution of the granuloma. Part 2: Biological therapy was introduced as a new option for treatment in uveitis refractory to the conventional therapy (corticosteroids and IMT). There are four main categories for biologics: TNF inhibitors, lymphocyte inhibitors, interferons and specific receptor antagonist. A total of 144 patients (262 eyes) were included and divided into 2 groups: group I: included 200 eyes with non anterior NIU. The mean age was 37.3±16.1 years. According to anatomical location, panuveitis was the most common representing 53.5%. Behcet disease and arthritis related uveitis were the commonest etiologies in our cohort (60.5%). In general, biologics were associated with stability or improvement of vision, reduction of systemic corticosteroids to safe dose ≤ 7.5 mg daily, stop the IMT or decrease it to a non therapeutic dose and reduction of flare up. The overall success rate was 77.3%, 71.6%, 64.8%, 57.6% and 45.1% at 12, 24, 36, 48, 60 months respectively. Among biologics used, Infliximab and adalimumab (Anti-TNF-α) were the most commonly used (84 %) with the same efficacy and safety profile. It is important to know the impact of both adalimumab and infliximab when deciding treatment with them (patients’ compliance and financially). In fact, adalimumab is given subcutaneous and add less to patients’ constrains but infliximab requires hospitalization. from the financial point, the treatment cost is slightly cheaper for humira than infliximab. group II: included 40 patients (62 eyes) with anterior NIU who received adalimumab to control systemic disease mostly ankylosing spondylitis (58.1 %) and Juvenile idiopathic uveitis (19.4 %). The mean age was 30.1±14.7 years. Adalimumab was associated with improvement of visual acuity, reduction of flare up by 40% and the ability to reduce steroid eye drops ≤ 3 or stop them. The mean time to decrease steroid drops was 29.4±21.2 days and the mean time to stop it was 22 weeks. Treatment of uveitis is challenging and should be tailored according to etiology and patients’ response to treatment with attention to the type of uveitis. Antiparastic medications give better results in treatment of trematode induced uveitis and should be kept in mind during treatment of these cases. In large granuloma with fear of fibrosis, surgical aspiration is a good choice. Biotherapies used in clinical practice for the treatment of non infectious uveitis represent an attractive alternative therapeutics in severe uveitis refractory to corticosteroids and IMT. But, their high cost has limited their use to refractory uveitis.