Uveítis y terapia anti-TNF

uveitis is responsible for visual loss of up to 10% of world population and is the second leading cause of treatable blindness in people of working age, after diabetic retinopathy. the treatment of noninfectious uveitis depends on its severity; there is a high percentage (up to 40%) of cases refractory to immunosuppressants and high-dose corticosteroids. tumor necrosis factor (tnf) is a key cytokine in the pathogenesis of noninfectious uveitis. several case reports, open trials and small randomized controlled trials with selective blocking of tnf with monoclonal antibodies (infliximab and adalimumab) and fusion proteins (etanercept) have shown efficacy in the treatment of refractory uveitis, in idiopathic and associated with autoimmune diseases, in preventing relapses, steroid-sparing effect and improvement of long-term visual prognosis. however, there are some reports of paradoxical effects, such as induction of uveitis associated with the use of etanercept. we performed a thorough review of the literature to determine the role of anti-tnf agents in the treatment of refractory non-infectious uveitis.