Ocular Immunology and Uveitis 2005

[Mike Bartolatz]

Ocular Immunology and Uveitis CME
Disclosures

C. Stephen Foster, MD


Introduction
The 77th meeting of the Association for Research in Vision and Ophthalmology (ARVO) was held in Ft. Lauderdale, Florida, April 30 to May 5, 2005. There were 5730 presentations, an increase of 120 from the previous year. Held in conjunction with ARVO was the meeting of the American Uveitis Society. Between the two meetings, there were several new findings presented on ocular immunology and uveitis. The importance of immunomodulatory therapy was again emphasized in several presentations, with the highlights from both meetings discussed in this article.

Highlights From the American Uveitis Society Meeting
Biology
The American Uveitis Society scientific meeting began with sessions seeking a further understanding of the biology of uveitis. Sohn and associates,[1] from the University of Louisville (Kentucky) Department of Ophthalmology and Visual Sciences, presented their results from a study of the local and systemic complement activation and its role in experimental autoimmune anterior uveitis (EAAU). The model was induced in Lewis rats by immunization with bovine melanin-associated antigen (MMA) emulsified in complete Freund's adjuvant and pertussis toxin. Anterior uveitis develops in the rats, and the degree of uveitis can be monitored both clinically and histopathologically by sacrificing rats at various time points (6 animals at each time point, with time points of 8, 10, 12, 14, 16, 19, 23, and 30 days after immunization). Serum complement levels were measured via CH50 hemolytic assay, and aqueous humor levels of complement were monitored by semiquantitative Western blot analysis of C3 split products.

One group of experimental animals was injected with cobra venom factor (CVF) to deplete complement from them in an effort to study the effect of complement depletion on the model and hence to draw conclusions about the role of complement in this experimental model of anterior uveitis. The investigators found that serum levels of complement increased in a time course identical to the increasing level of uveitis, with a very strong correlation between the serum complement activity and the EAAU score. Similarly, C3 split products in the aqueous humor rose with increasing EAAU score, and fell as the uveitis resolved. A single injection of CVF on day 9 following MMA immunization resulted in complete complement depletion for 5 days, and also abrogated the expression of the uveitis model. The investigators concluded that complement activation is involved in the development of uveitis in this model.

Langford and colleagues,[2] from the Louisiana State University Department of Ophthalmology, presented immunocytologic evidence for excitatory amino acid transporter regulation of glutamate in rabbit blood-aqueous barrier epithelia. Since the transport activity of high-affinity glutamate (Glu) transporters can modulate paracellular permeability of barrier epithelial cells, and since uveitis affects such cells and intracellular gap junctions and barrier integrity, these researchers investigated the relationship between excitatory amino acid transporters (EAAT1-3, GLAST-1, GLT-1 and EAAC-1) and Glu in rabbit ciliary body epithelial cells. Glu was detected in both nonpigmented epithelial (NPE) and in pigmented epithelial (PE) cells, highly concentrated at the apical surface of NPE cells. All 3 EAAT proteins were detected; in different epithelial cell layers lining the ciliary processes, GLAST-1 was primarily localized to the basal surface of the NPE cells. GLT-1 was detected in both PE and in NPE cell layers. EAAC-1 was associated with the basal surface of the PE cells. The co-localization of the EAATs and Glu in ciliary epithelial cell layers suggested to the investigators coordinated action between the high-affinity EAATs to maintain the high intracellular concentration of Glu in the NPE cells. Further, they opined that the concentrated Glu by NPE cells supports a role for Glu transporter activity in regulation of the extracellular Glu levels and modulation of paracellular permeability controlled by the NPE cell tight-junction complexes. This, then, led the investigators to conclude that Glu-dependent NPE cell permeability may be a target for proinflammatory agents, such as prostaglandins that modulate EAAT activity.

Vogt-Koyanagi-Harada Disease
Researchers from Johns Hopkins School of Medicine Department of Ophthalmology (Baltimore, Maryland), led by Jennifer Thorne,[3] analyzed their patients with Vogt-Koyanagi-Harada (VKH) disease, with special attention to outcomes (particularly visual acuity) at the time of most recent follow-up evaluation. Twenty-four patients were available for analysis; these patients had received their care at the Wilmer Institute at Johns Hopkins between November 1984 and May 2004. Data were collected by chart review, and the data were analyzed with time-dependent techniques. Incidence of visual impairment and of structural damage to the eye was calculated, as were the effects of corticosteroid and of immunomodulatory therapy on the incidence of visual impairment and of eye damage. The data revealed that at the time of first presentation to the doctors at Johns Hopkins, the frequency of vision loss to 20/50 or worse was 50% in the better seeing eye; 30% of better seeing eyes had even worse vision, 20/200 or worse. These are rather shocking figures, particularly when compared with those reported by a similarly famous tertiary referral center in Tokyo, Japan, where visual acuity at first presentation is reported at Kyorin University School of Medicine, Department of Ophthalmology, by Okada and colleagues.[4] What can account for these disparate experiences?

The evidence strongly suggests that, as a consequence of the prevalence of VKH in Japan and the opportunity for most Japanese ophthalmologists to personally evaluate patients with this disorder, Japanese ophthalmologists are extremely familiar with VKH and with its poor outcomes without treatment or even with prolonged corticosteroid treatment as monotherapy; hence, Japanese comprehensive ophthalmologists and vitreo-retinal specialists rapidly refer patients with VKH to uveitis specialists at tertiary referral centers (ie, immediately upon encountering such a patient). American and European ophthalmologists, on the other hand, have little opportunity to personally evaluate and manage patients with VKH because of the scarcity of such patients in these parts of the world. Thus, in America and in Europe, such patients appear to be managed for much longer periods of time prior to referral to the uveitis specialist.

The Hopkins researchers found that the rates of vision loss to 20/50 or worse and to 20/200 or worse in their 24 patients with VKH were 9% per person-year (PY) and 7% per PY respectively in better-seeing eyes. Oral corticosteroid therapy was associated with reduced risk of loss of visual acuity to 20/200 or worse in better-seeing eyes, while immunomodulatory therapy was associated with a reduced risk of vision loss both to the 20/50 or worse and to the 20/200 or worse levels in better-seeing eyes. It is worth emphasizing here that evidence-based analytical exercises have concluded that, while systemic corticosteroid therapy is important and appropriate initial care for patients with VKH, immunomodulatory therapy is the more prudent and appropriate strategy for the long term.[5] The Hopkins team concluded that VKH can result in substantial visual loss, and that the use of corticosteroids and immunomodulatory medications may reduce the risk of such vision loss.

Interesting Cases
Emilio Dodds,[6] from Buenos Aires, Argentina, reported the outcomes of his treatment with chlorambucil of 5 patients who had sympathetic ophthalmia. The therapy was high-dose, short-term, with a mean dose of 26.8 mg and mean duration of 3.5 months. Follow-up ranged from 30 to 48 months, and all patients were in complete remission off therapy during that follow-up. Vision improved (mean acuities) from 20/100 to 20/40. Dodds concluded that chlorambucil, high-dose, short-term, is an effective therapy for remission induction of sympathetic ophthalmia.

Lyndell and associates,[7] from the University of Oregon, reported an unusual case of uveitis caused by Borrelia hamsii (rather than by the burgdorferi family member). The patient, a 12-year-old boy, had experienced relapsing fevers for 2 weeks, beginning 10 days after he had vacationed in a forest cabin in central Oregon. Serologic studies led to the causative suspect, and therapy with intravenous ceftriaxone, followed by 4 weeks of oral cefuroxime therapy, resulted in resolution of the fevers. Uveitis occurred subsequently (intermediate uveitis); doxycycline 100 mg/day was begun and continued for 4 weeks, with resolution of the uveitis.

The final presentation at the meeting of the American Uveitis Society was one from investigators at the University of California, San Francisco,[8] with a description of a 75-year-old man with diabetes mellitus and diabetic macular edema who was given an intravitreal injection of triamcinolone acetonide (4 mg) for the edema. The patient subsequently developed full-thickness retinal whitening in an arcuate pattern, suggestive of viral acute retinal necrosis. Diagnostic vitrectomy with polymerase chain reaction analysis of the harvested material disclosed cytomegalovirus DNA. The patient tested negative for the human immunodeficiency virus, and the infection responded well to intravitreal ganciclovir (2 mg) and oral valganciclovir. The infection recurred with discontinuation of the valganciclovir, again with diagnostic confirmation by vitreous biopsy, but once more responded to antiviral therapy.

Highlights From ARVO: Clinical Uveitis
Diagnostic Techniques
Baarsma and associates,[9] from the Department of Ophthalmology at the Eye Hospital in Rotterdam, The Netherlands, addressed the matter of diagnostic sensitivity and specificity of the Goldmann-Witmer coefficient (GWC), comparing it with polymerase chain reaction (PCR) analysis results from aqueous humor and from vitreous from 92 patients with uveitis suspected to be of infectious etiology. PCR had a higher positive yield (62%) than did GWC (48%). But GWC was positive for herpesvirus antibodies in a significant number of ocular fluid specimens that were negative by PCR (22% in ARN cases and 16% in non-ARN cases), demonstrating, to the authors' satisfaction, the usefulness of GWC even in the day of PCR availability. The authors consider the two tests complementary, and I agree with that, believing that it is a major pity that GWC has never caught on as a diagnostic technique for uveitis specialists in the United States.

Medical Therapy
Researchers from France[10] reported on their experience with interferon (IFN) alpha 2a in the care of 45 patients with severe, otherwise treatment-resistant uveitis. Twenty-three of the patients had uveitis associated with Adamantiades-Behcet's disease (ABD), and the duration of the uveitis for the entire group prior to interferon therapy was (mean) 50 months. The uveitis was controlled with IFN therapy in 83% of the ABD patients and in 59% of the remaining ones, allowing tapering of systemic corticosteroid therapy. IFN was discontinued in 10 patients with ABD, and 40% relapsed and required resumption of therapy, leading the authors to conclude that, while effective as ongoing therapy, IFN is not curative.

The new sustained steroid release device from Bausch and Lomb (fluocinolone acetonide) recently approved for sale and distribution in the United States for care of patients with intermediate and posterior uveitis was evaluated in 278 patients in a 2-dose, double-masked, randomized multicenter trial in the United States. The results of that trial led the United States Food and Drug Administration to conclude that the device, which delivers fluocinolone acetonide at a constant rate into the vitreous cavity over 3 years, was a safe and effective drug and delivery device system that can be offered to patients with otherwise treatment-resistant uveitis. The trial results were presented by Jaffee for the investigator group,[11] with a 4% recurrence of uveitis in implanted eyes during the first year after surgery, compared with 56% recurrence in the nonimplanted fellow eyes. Visual acuity improved by 3 or more lines in 26% of implanted eyes, compared with 6% of the fellow, nonimplanted eyes. Systemic corticosteroid and/or systemic immunomodulatory therapy was successfully reduced without flare-up of uveitis, with 59% of patients receiving such therapy at baseline, and only 12% receiving such therapy at the 1-year follow-up evaluation. Similarly, requirements for regional corticosteroid injection therapy were also dramatically reduced, with 71% of study eyes requiring such therapy during the 1 year prior to implantation of the drug device, and only 4% requiring injections of corticosteroid because of uveitis during the first year after implantation. Cataract and glaucoma were the main adverse events seen in implanted eyes, with 26% of implanted eyes requiring cataract surgery and 12% requiring glaucoma surgery.

Suhler and associates,[12] from the University of Oregon Department of Ophthalmology, examined the safety and efficacy of intravenous infliximab in the care of 31 patients with otherwise treatment-resistant uveitis. Five patients had been on therapy for 2 years; 18 had been on therapy for 1 year; 28 patients had had at least 10 weeks of infliximab therapy. Treatment success had been declared for 22 of the 28 patients reaching the 10-week mark, for 9 of the 18 reaching the 1-year point in therapy, and for only 1 of the 5 who had reached the 2-year mark. The investigators encountered a higher than expected rate of toxicity, with drug-induced systemic lupus erythematosus developing in 3 patients (ANA positivity developed in 13 of 18 patients who reached the 1-year treatment mark), cancer occurring in 1 patient, thromboembolic events developing in 3 others, and 1 case each of congestive heart failure and infection.

Researchers in England have continued their excellent work in the areas of pediatric uveitis in general and methotrexate therapy in particular. Edelsten and associates,[13] from Ipswich Hospital in Ipswich and from Great Ormond Street Hospital in London, examined 54 children (84 involved eyes) who were treated with methotrexate, on average, 2.6 years after the onset of what turned out to be otherwise treatment-resistant uveitis. The authors defined remission as lack of uveitis flare up for at least 6 months on 1 drop of steroid or less each day, and control as lack of inflammation while still on more than 1 drop of steroid a day. The outcomes data disclosed that at 1 year of methotrexate treatment, 49% of eyes were controlled, while only 5% met the criterion of remission. At 5 years of methotrexate therapy, 81% of the eyes were controlled and 48% were in remission. However, examination of the data with respect to retention of control or remission after discontinuation of methotrexate disclosed that only 20% of the patients met the definition of control, and even fewer (6%) were in remission off methotrexate -- leading the authors to conclude that while the majority of methotrexate-treated patients are controlled within a year of beginning therapy, few actually achieve a cure, with freedom from relapse off medication. The authors are of the opinion that alternative immunomodulatory therapy is justified in those methotrexate-treated patients who are not adequately controlled within 1 year of therapy, particularly if the patient is one who is at high risk for ocular complications from the uveitis. The major risk factor for such risk is the severity of the uveitis at the moment of first presentation to the uveitis specialist.

Vianna and associates[14] studied the long-term outcomes of 19 patients (37 eyes) with multifocal choroiditis and panuveitis (MCP), with mean follow-up time of over 7 years. Kaplan-Meier survival curve analysis led to the conclusion that patients with MCP lose vision over time despite corticosteroid therapy. Indeed, the authors concluded that the vision loss occurs as a consequence of both the complications of the uveitis and the complications of long-term use of corticosteroids. Cataract, glaucoma, maculopathy, and choroidal neovascularization were the primary complications noted.

Similar conclusions have been reached by multiple other groups for cohorts of patients with birdshot retinochoroidopathy (BSRC), with immunomodulatory therapy providing for outcomes superior to those seen with untreated or steroid-treated patients. However, not all patients with BSRC can be treated with conventional immunomodulatory agents. Huang and associates,[15] from the Massachusetts Eye Research and Surgery Institute in Boston, reported preliminary observations on 7 patients with BSRC who eventually were treated with intravenous daclizumab, a humanized monoclonal antibody directed against the activation glycoprotein on the surface of activated T lymphocytes, the CD25 glycoprotein. This agent, marketed for the treatment of patients experiencing a kidney allograft rejection reaction, has been used "off label" for the treatment of several autoimmune disorders, and hence its use in these otherwise treatment-resistant patients who had deteriorating visual function as a consequence of BSRC activity. Inflammation was successfully controlled and vision stabilized or improved in all 7 patients. Additionally, objective parameters of BSRC activity, including late staining of vasculature and/or optic nerve on fluorescein angiography, and prolongation of the 30 Hz implicit time on ERG testing confirmed the improvement noted on subjective observations of visual acuity and clinical assessment of inflammation. No adverse events were noted out to 16 months of therapy with 1 mg/kg body weight per intravenous infusion, with infusions beginning once every 2 weeks for 3 months and then being slowly spread out, with increasing time intervals between infusions. The therapy salvaged the vision of these 7 patients who experienced progressive deterioration prior to the initiation of daclizumab therapy. Unfortunately, none of the patients has experienced a durable remission that would enable them to discontinue the treatment.

The efficacy of chronic oral nonsteroidal anti-inflammatory drug (NSAID) therapy for prevention of uveitis relapse in patients with a history of recurrent HLA-B27-associated uveitis was studied by Teasley and colleagues[16] at the Ocular Immunology and Uveitis Foundation in Boston. Forty-three patients (86 eyes) were studied, and the pre-NSAID and post-NSAID attack rates were compared. The average pre-NSAID attack rate was 1 episode every 12.8 months; the post-NSAID rate was 1 attack every 38.3 months, off all corticosteroid therapy. Five patients experienced gastrointestinal discomfort which was alleviated by a change in the NSAID being employed. The authors concluded that there was a 66.8% reduction in recurrences of uveitis in this population of patients with recurrent HLA-B27-associated uveitis through the chronic use of oral NSAIDs, with complete freedom from steroid use. They are now attempting to mount a double-masked, randomized, placebo-controlled clinical trial on this matter.

The subject of IFN alpha 2a therapy for patients with Adamantiades-Behcet's disease (ABD) was once again addressed by the group from the University of Tubingen (Germany),[17] with reports that all 30 eyes of 17 patients were controlled, with improved vision in 60% of eyes and stable acuity in 40%. The doctors concluded, again, that such therapy is safe and effective for the care of patients with uveitis associated with ABD. They recommended that an earlier rather than later switch to IFN therapy occur in those ABD patients who appear to be failing more conventional immunomodulatory therapy. The most serious side effects of such therapy include profound depression, leucopenia, and flu-like syndrome following every injection, which must be done 3 times a week.

Surgical Care
On the matter of surgical care of patients with uveitis, Choi and colleagues,[18] from the Massachusetts Eye Research and Surgery Institute (MERSI) in Boston, described the results of a pilot study comparing the efficacy of systemic immunomodulatory therapy (IMT) with pars plana vitrectomy (PPV) in the care of patients with pars planitis who continue to have recurrent inflammation despite a series of regional corticosteroid injections. The study was randomized but (obviously) not masked. Eighteen-month results were reported on 16 patients (20 eyes). The investigators employed the null hypothesis in their analysis -- ie, that there is no difference in the efficacy of the 2 treatment approaches -- and the examination of the results was aimed at seeing if the null hypothesis could be rejected -- ie, the 2 treatments are different, one being better than the other. Eighty-two percent of the patients treated with PPV were cured, ie, free of all inflammation off all steroids at all times. Six of 11 IMT patients continued to have active episodes of pars planitis, and all were eventually treated with PPV with successful resolution of the problem. Despite these obvious differences in apparent success, this pilot study, underpowered as it is, fails to allow rejection of the null hypothesis -- ie, the two treatments, statistically, are equivalent. But the apparent differences suggest that a randomized multicenter study of this matter would be well justified.

The same Boston research team at MERSI[19] also investigated the use of the Ahmed glaucoma valve implant device for the care of uveitic glaucoma in children. Six patients (7 eyes) underwent the surgery because of progressive glaucomatous optic neuropathy on maximum medical therapy. All patients had required immunomodulatory therapy to prevail over their uveitis, and all were in remission on such therapy at the time of the valve surgery. The postoperative follow-up ranged from 6 to 60 months. The preoperative intraocular pressures ranged from 26-52 mm Hg (mean 37 mm Hg); the postoperative pressures ranged from 9-18 mm Hg (mean 12), a 70% reduction in intraocular pressure. The number of topical hypotensive agents required for good pressure control decreased (preoperative vs postoperative) by 0.7 medications. These researchers had previously demonstrated the effectiveness of the Ahmed glaucoma valve implant device in the care of adults with uveitic glaucoma, and in that group of patients it seemed clear that one factor in ensuring success was the longitudinal control of uveitis with immunosuppressive chemotherapy. Hence, such control was a defining element in the protocol followed by the researchers in their study of children with the same problem.

Immunomodulatory Therapy: Underscoring Its Importance
On the matter of immunomodulatory therapy for treatment of patients with uveitis, multiple learned bodies have reviewed the literature and come to the conclusion that such therapy represents the standard of care in patients with certain diseases and syndromes and in patients with steroid-dependent or steroid-resistant uveitis. Yet the general ophthalmologists of the world generally appear to simply continue to rely upon steroids as monotherapy for their patients with uveitis. Samson and colleagues[20] at New York University School of Medicine, Department of Ophthalmology, decided to survey ophthalmology training program directors in the United States on whether an ocular immunologist served on their faculty, and whether specific, dedicated training in uveitis was included in the pedagogy of the training program. They also surveyed colleagues on their knowledge of the names of various immunomodulatory agents and on their opinions of whether or not immunomodulatory therapy represented the standard of care in selected (see above) instances.

The results of these surveys are astounding, and they provide great insight, in my opinion, into why ophthalmologists continue to rely upon corticosteroid therapy alone in their care of patients with chronic or recurrent uveitis. A minority of training programs have an ocular immunologist on the faculty. Few programs without an ocular immunologist on the faculty have a dedicated pedagogy for uveitis. Forty-five percent of the ophthalmologists surveyed did not feel that they knew, adequately, the indications for referral of a uveitis patient to a uveitis specialist for consideration of immunomodulatory therapy, and 17% expressed the opinion that such therapy does not represent the standard of care for patients with uveitis that is steroid-dependent or treatment-resistant. We suspect that this lack of knowledge will continue until more ophthalmology residents graduating from ophthalmology training programs have had the opportunity to learn about the graduated, stepladder approach in aggressiveness of therapy, including immunomodulatory therapy, in such uveitis patients, as a consequence of the teaching from an ocular immunologist on the faculty of the training program.

References
Sohn JH, Jha P, Xu Q, Kaplan HJ, Bora PS, Bora NS. Local and systemic complement activation in experimental autoimmune anterior uveitis. Program and abstracts of the American Uveitis Society at the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 1.
Langford MP, Liang C, Kooragayala LM. Immunocytologic evidence for excitatory amino acid transporter regulation of glutamate in rabbit blood-aqueous barrier epithelia. Program and abstracts of the American Uveitis Society at the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2.
Thorne JE, Bykhovskaya I, Jabs DA, Kempen JH, Dunn JP. Vogt-Koyanagi-Harada disease: vision and clinical outcomes. Program and abstracts of the American Uveitis Society at the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 3.
Okada AA, Kojima E, Sugahara M, Watanabe T, Sugiyama W. Pulse intravenous methylprednisolone for Vogt-Koyanagi-Harada disease. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2385.
Jabs DA, Rosenbaum JT. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disease: recommendations of an expert panel. Am J Ophthalmol. 2000;130:492-513. Abstract
Dodds EM. Sympathetic ophthalmia treated with chlorambucil. Program and abstracts of the American Uveitis Society at the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 5.
Lim LL, Rosenbaum JT. Uveitis caused by Borrelia hamsii. Program and abstracts of the American Uveitis Society at the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 7.
Saidel MA, Berreen J, Margolis TP. A Case of cytomegalovirus retinitis after intravitreous injection of triamcinolone. Program and abstracts of the American Uveitis Society at the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 8.
Baarsma SG, Missotten TO, Kuipers RW, Verjans GM. PCR and Goldmann-Witmer coefficient: diagnostic value in uveitis of suspected infectious origin. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2383.
Gendron G, Bodaghi B, Wechsler B, et al. Efficacy and tolerance of interferon alpha in the treatment of refractory and sight-threatening uveitis: a retrospective monocentric study of 45 patients. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2384.
Jaffee GJ, Martin D, Callanan D, Levy B. Fluocinolone acetonide intravitreal implant to treat posterior uveitis: 2-year results of a multi-center clinical trial. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2386.
Suhler EB, Smith JR, Pickard TD et al. A prospective trial of infliximab therapy in patients with refractory uveitis: trials and tribulations, successes and setbacks. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2387.
Edelsten C, Daud DS, Cunniffe MG. Factors influencing course of uveitis in children taking methotrexate. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2388.
Vianna RN, Ozdal PC, Filho JP, et al. Long-term follow-up of patients with multifocal choroiditis and panuveitis. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2827.
Huang JJ, Choopong P, Kafkala C, et al. Efficacy of daclizumab treatment of patients with Birdshot Retinochoroidopathy refractory to corticosteroid-sparing systemic immunosuppressive therapy. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2834.
Teasley LA, Ahmed M, Androudi S, et al. Oral non-steroidal anti-inflammatory drug therapy for HLA-B27 positive patients with chronic non-infectious uveitis. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2831.
Deuter CM, Koetter I, Stuebiger N, et al. Behcet's disease: visual prognosis after treatment with interferon alfa-2a. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2840.
Choi JY, Kafkala C, Foster CS. Pars plana vitrectomy versus immunomodulatory therapy in a prospective randomized trial for treatment of pars planitis. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2830.
Foster CS, Kafkala C. Choi JY. Ahmed valve implantation for uveitic glaucoma in children. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2824.
Barone SB, Narayana K, Latkany P, et al. Survey on the knowledge of immunosuppressive agents for uveitis among non-uveitis specialists. Program and abstracts of the Association for Research in Vision and Ophthalmology; May 1-5, 2005; Fort Lauderdale, Florida. Abstract 2847.



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