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Birdshot uveitis: current and emerging treatment options.

Menezo, V and Taylor, SR (2014) Birdshot uveitis: current and emerging treatment options. Clin Ophthalmol, 8. pp. 73-81.

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Abstract

Birdshot chorioretinopathy is a relatively uncommon subtype of idiopathic posterior uveitis with distinct clinical characteristics and a strong genetic association with the Human Leukocyte Antigen (HLA)-A29 allele. The diagnosis remains clinical and is based on the presence of typical clinical features, including multiple, distinctive, hypopigmented choroidal lesions throughout the fundus. The long-term visual prognosis of this disorder, however, remains guarded - central visual acuity can be preserved until late in the disease and it is not uncommon for patients to receive inadequate immunosuppressive treatment, leading to a poor long-term outcome in which peripheral retinal damage eventually leads to visual deterioration. Birdshot chorioretinopathy has proven a particularly attractive area of study within the field of uveitis, as it is a relatively easily defined disease with an associated human leukocyte antigen haplotype. Despite this, however, the immune mechanisms involved in its pathogenesis remain unclear, and some patients continue to lose retinal function despite therapy with corticosteroids and conventional immunosuppressive agents. Laboratory research continues to investigate the underlying mechanisms of disease, and clinical research is now being driven to improve the phenotyping and monitoring of this condition as, in the era of so-called personalized medicine, it is becoming increasingly important to identify patients at risk of visual loss early so that they can be treated more aggressively with targeted therapies such as the newer biological agents. This approach requires the formation of collaborative groups, as the relative rarity of the condition makes it difficult for one center to accumulate enough patients for worthwhile studies. Nevertheless, results obtained with newer therapies, such as biological agents directed against particular cytokines or cell-surface receptors, demonstrate ever improving control of the inflammation in refractory cases, providing hope that the outlook for visual function in this condition can only improve.

Item Type: Article
Subjects : Clinical Medicine
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine > Department of Clinical and Experimental Medicine
Authors :
AuthorsEmailORCID
Menezo, VUNSPECIFIEDUNSPECIFIED
Taylor, SRUNSPECIFIEDUNSPECIFIED
Date : January 2014
Identification Number : 10.2147/OPTH.S54832
Uncontrolled Keywords : HLA-A29, Th17 cells, birdshot chorioretinopathy, interleukin antagonists, monoclonal antibodies, retinal vasculitis
Related URLs :
Additional Information : © 2014 Menezo and Taylor. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php
Depositing User : Symplectic Elements
Date Deposited : 11 Mar 2016 13:46
Last Modified : 11 Mar 2016 13:46
URI: http://epubs.surrey.ac.uk/id/eprint/810103

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