Leitlinie Nr. 24b der DOG und BVA^[*]

Leitlinien sind Orientierungshilfen im Sinne von „Handlungs- und Entscheidungskorridoren“, von denen in begründeten Fällen abgewichen werden kann oder sogar muss. Sie beschreiben, was Augenärzte für eine angemessene Patientenversorgung in der Praxis und Klinik für geboten halten. Dies entspricht nicht immer dem Leistungsniveau der gesetzlichen Krankenversicherung in Deutschland (s. Präambel, [11]).

^* Bei der vorliegenden Leitlinie handelt es sich um eine S1-Leitlinie zur „Nichtinfektiösen Uveitis posterior“. Der Verfahrensablauf der Erstellung der Leitlinie wird im Appendix geschildert.

• Literatur

• 1 Absasolo L, Rosales Z, Diaz-Valle D. et al. Immunosuppressive drugs discontinuation in noninfectious uveitis from real-life clinical practice: a survival analysis. Am J Ophthalmol 2016; DOI: 10.1016/j.ajo.2016.06.007.
• 2 Adan A, Mesquida M, Llorenc V. et al. Tocilizumab treatment for refractory uveitis-related cystoid macular edema. Graefes Arch Clin Exp Ophthalmol 2013; 251: 2627-2632 (III)
• 3 Andrasch RH, Pirofsky B, Burns RP. Immunosuppressive therapy for severe chronic uveitis. Arch Ophthalmol 1978; 96: 247-251
• 4 Androudi S, Tsironi E, Kalogeropoulos C. et al. Intravitreal adalimumab for refractory uveitis-related macular edema. Ophthalmology 2010; 117: 1612-1616 (III)
• 5 Arida A, Fragiadaki K, Giavri E. et al. Anti-TNF agents for Behçetʼs disease: analysis of published data on 369 patients. Semin Arthritis Rheum 2011; 41: 61-70 10.1016/j.semarthrit.2010.09.002
• 6 Artornsombudh P, Gevorgyan O, Payal A. et al. Infliximab treatment of patients with birdshot retinochoroidopathy. Ophthalmology 2013; 120: 588-592 (III)
• 7 Baltatzis S, Tufail F, Yu EN. et al. Mycophenolate mofetil as an immunomodulatory agent in the treatment of chronic ocular inflammatory disorders. Ophthalmology 2003; 110: 1061-1065 (III)
• 8 Baughman RP, Lower EE, Bradley DA. et al. Etanercept for refractory ocular sarcoidosis: results of a double-blind randomized trial. Chest 2005; 128: 1062-1047 (Ib)
• 9 Becker MD, Heiligenhaus A, Hudde T. et al. Interferon as a treatment for uveitis associated with multiple sclerosis. Br J Ophthalmol 2005; 89: 1254-1257 (III)
• 10 BenEzra D, Cohen E, Chajek T. et al. Evaluation of conventional therapy versus cyclosporine A in Behçetʼs syndrome. Transplant Proc 1988; 20: 136-143 (Ib)
• 11 Berufsverband der Augenärzte Deutschlands e.V. (BVA), Deutsche Ophthalmologische Gesellschaft. Leitlinien von BVA und DOG. 2013 Im Internet: http://www.augeninfo.de/leit/leitvo.htm
• 12 http://cms.augeninfo.de/fileadmin/stellungnahmen/Stellungnahme_zur_Therapie_der_chorioidalen_Neovaskularisation Stand: 26.9.2017
• 13 http://cms.augeninfo.de/fileadmin/stellungnahmen/Stellungnahme_Ocriplasmin_01.pdf Stand: 26.9.2017
• 14 Callanan DG, Jaffe GJ, Martin DF. et al. Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results. Arch Ophthalmol 2008; 126: 1191-1201 (Ib)
• 15 Calvo-Río V, Blanco R, Beltrán E. et al. Anti-TNF-α therapy in patients with refractory uveitis due to Behçetʼs disease: a 1-year follow-up study of 124 patients. Rheumatology (Oxford) 2014; 53: 2223-2231 (Ib)
• 16 Cruz BA, Reis DD, Araujo CA. Minas Gerais Vasculitis Study Group. Refractory retinal vasculitis due to sarcoidosis successfully treated with infliximab. Rheumatol Int 2007; 27: 1181-1183
• 17 Davatchi F, Shams H, Rezaipoor M. et al. Rituximab in tractable ocular lesions of Behcetʼs disease: randomized single-blind control study (pilot study). Int J Rheum Dis 2010; 13: 246-252
• 18 De Smet MD, Taylor SR, Bodaghi B. et al. Understanding uveitis: the impact of research on visual outcomes. Prog Retin Eye Res 2011; 30: 452-470 10.1016/j.preteyeres.2011.06.005 (IV)
• 19 de Vries J, Baarsma GS, Zaal MJ. et al. Cyclosporin in the treatment of severe chronic idiopathic uveitis. Br J Ophthalmol 1990; 74: 344-349 (Ib)
• 20 Deuter CM, Doycheva D, Stuebiger N. et al. Mycophenolate sodium for immunosuppressive treatment in uveitis. Ocul Immunol Inflamm 2009; 17: 415-419 (III)
• 21 Dick AD, Tundia N, Sorg R. et al. Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Ophthalmology 2016; 123: 655-662 (IIb)
• 22 http://www.dog.org/wp-content/uploads/2013/03/zur-intravitrealen-Therapie-des-Makulaoedems-bei-Uveitis-Stand-02.07.2014.pdf Stand: 26.9.2017
• 23 Doycheva D, Jägle H, Zierhut M. et al. Mycophenolic acid in the treatment of birdshot chorioretinopathy: long-term follow-up. Br J Ophthalmol 2015; 99: 87-91 (III)
• 24 Dunn JP. Review of immunosuppressive drug therapy in uveitis. Curr Opin Ophthalmol 2004; 15: 293-298 (III)
• 25 http://www.dv-osteologie.org/uploads/Leitlinie/2014/DVO-Leitlinie/Osteoporose/2014/Kitteltaschenversion/15.12.2014.pdf Stand: 26.9.2017
• 26 Esterberg E, Acharya NR. Corticosteroid-sparing therapy: practice patterns among uveitis specialists. J Ophthalmic Inflamm Infect 2012; 2: 21-28 (IV)
• 27 Engelhard SB, Patel V, Reddy AK. Intermediate uveitis, posterior uveitis, and panuveitis in the Mid-Atlantic USA. Clin Ophthalmol 2015; 9: 1549-1555 (III)
• 28 Farvardin M, Afarid M, Mehryar M. et al. Intravitreal infliximab for the treatment of sight-threatening chronic noninfectious uveitis. Retina 2010; 30: 1530-1535 (III)
• 29 Fend F, Ferreri AJ, Coupland SE. How we diagnose and treat vitreoretinal lymphoma. Br J Haematol 2016; 173: 680-692 (III)
• 30 French Behçet Network. Vallet H, Riviere S, Sanna A. et al. Efficacy of anti-TNF alpha in severe and/or refractory Behçetʼs disease: multicenter study of 124 patients. J Autoimmun 2015; 62: 67-74 (Ib)
• 31 Galor A, Jabs DA, Leder HA. et al. Comparison of antimetabolite drugs as corticosteroid-sparing therapy for noninfectious ocular inflammation. Ophthalmology 2008; 115: 1826-1832 (III)
• 32 Gangaputra S, Newcomb CW, Liesegang TL. et al. Methotrexate for ocular inflammatory diseases. Ophthalmology 2009; 116: 2188-2198.e1 (III)
• 33 Garcês S, Demengeot J, Benito-Garcia E. The immunogenicity of anti-TNF therapy in immune-mediated inflammatory diseases: a systematic review of the literature with a meta-analysis. Ann Rheum Dis 2013; 72: 1947-1955 (Ia)
• 34 Gaudio PA. A review of evidence guiding the use of corticosteroids in the treatment of intraocular inflammation. Ocul Immunol Inflamm 2004; 12: 169-192 (IV)
• 35 Greenwood AJ, Stanford MR, Graham EM. The role of azathioprine in the management of retinal vasculitis. Eye 1998; 12: 783-788 (III)
• 36 Gritz DC, Wong IG. Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study. Ophthalmology 2004; 111: 491-500 (IIb)
• 37 Hatemi G, Silman A, Bang D. et al. Management of Behçet disease: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for the management of Behçet disease. Ann Rheum Dis 2009; 68: 1528-1534 (II)
• 38 Hazirolan D, Pleyer U. Think global-act local: intravitreal drug delivery systems in chronic noninfectious uveitis. Ophthalmic Res 2013; 49: 59-65 (IV)
• 39 Heiligenhaus A, Thurau S, Hennig M. et al. Anti-inflammatory treatment of uveitis with biologicals: new treatment options that reflect pathogenetic knowledge of the disease. Graefes Arch Clin Exp Ophthalmol 2010; 248: 1531-1551 (IV)
• 40 Heiligenhaus A, Breitbach M, Spital G. et al. Posteriore Uveitis Teil 1: Diagnose und Grundkonzepte der Therapie. Klin Monatsbl Augenheilkd 2014; 231: 457-469 (IV)
• 41 Heiligenhaus A, Breitbach M, Spital G. et al. Posteriore Uveitis. Teil 2: Die unterschiedlichen Krankheitsbilder. Klin Monatsbl Augenheilkd 2014; 231: 555-579 (IV)
• 42 Hogan AC, McAvoy CE, Dick AD. et al. Long-term efficacy and tolerance of tacrolimus for the treatment of uveitis. Ophthalmology 2007; 114: 1000-1006 (III)
• 43 Islam SM, Tabbara KF. Causes of uveitis at the eye center in Saudi Arabia: a retrospective review. Ophthalmic Epidemiol 2002; 9: 239-249
• 44 Jabs DA, Rosenbaum JT, Foster CS. et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol 2000; 130: 492-513 (IIb)
• 45 Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 2005; 140: 509-516 (IIb)
• 46 Jaffe GF, Dick AD, Brezin AP. et al. Adalimumab in patients with active non-infectious uveitis: VISUAL-1 Trial. N Engl J Med 2016; 375: 932 10.1056/NEJMoa1509852 (Ib)
• 47 Jakob E, Reuland MS, Mackensen F. et al. Uveitis subtypes in a German interdisciplinary uveitis center – analysis of 1916 patients. J Rheumatol 2009; 36: 127-136 (III)
• 48 Kacmaz RO, Kempen JH, Newcomb C. et al. Cyclosporine for ocular inflammatory diseases. Ophthalmology 2010; 117: 576-584 (Ib)
• 49 Kaplan-Messas A, Barkana Y, Avni I. et al. Methotrexate as a first-line corticosteroid-sparing therapy in a cohort of uveitis and scleritis. Ocul Immunol Inflamm 2003; 11: 131-139 (III)
• 50 Kempen JH, Gangaputra S, Daniel E. et al. Long-term risk of malignancy among patients treated with immunosuppressive agents for ocular inflammation: a critical assessment of the evidence. Am J Ophthalmol 2008; 146: 802-812 (Ib)
• 51 Kempen JH, Van Natta ML, Altaweel MM. et al. Factors predicting visual acuity outcome in intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment (MUST) trial. Am J Ophthalmol 2015; 160: 1133-1141 (Ib)
• 52 Kreider ME, Hansen-Flaschen J, Ahmad NN. et al. Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease. Ann Thorac Surg 2007; 83: 1140-1144 10.1016/j.athoracsur.2006.10.002
• 53 Lau CH, Comer M, Lightman S. Long-term efficacy of mycophenolate mofetil in the control of severe intraocular inflammation. Clin Experiment Ophthalmol 2003; 31: 487-491 (III)
• 54 Lerman A, Lewen MD, Kempen JH. et al. Uveitis reactivation in children treated with tumor necrosis factor alpha inhibitors. Am J Ophthalmol 2015; 160: 193-200 (IIb)
• 55 Levy-Clarke G, Jabs DA, Read RW. et al. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology 2014; 121: 785-796 (Ib)
• 56 Lowder C, Belfort jr. R, Lightman S. et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol 2011; 129: 545-553 (Ib)
• 57 Markomichelakis NN, Theodossiadis PG, Pantenelia E. et al. Infliximab for chronic macular edema associated with uveitis. Am J Ophthalmol 2004; 138: 648-650 (IV)
• 58 Markomichelakis NN, Demicha E, Masselos S. et al. Intravitreal infliximab for sight-threatening relapsing uveitis in Behcet disease: a pilot study in 15 patients. Am J Ophthalmol 2012; 154: 534-541 (IV)
• 59 Masuda K, Nakajima A, Urayama A. et al. Double-masked trial of cyclosporine versus colchicine and long-term open study of cyclosporin in Behçetʼs disease. Lancet 1989; 1: 1093-1096 (Ib)
• 60 Mochizuki M, Masuda K, Sakane T. et al. A clinical trial of FK506 in refractory uveitis. Am J Ophthalmol 1993; 115: 763-769 (IIa)
• 61 Murphy CC, Greiner K, Plskova J. et al. Cyclosporine vs. tacrolimus therapy for posterior and intermediate uveitis. Arch Ophthalmol 2005; 123: 634-641 (Ib)
• 62 Nguyen QD, Merrill PT, Jaffe GJ. et al. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet 2016; DOI: 10.1016/S0140-6736(16)31339-3.
• 63 Nussenblatt RB, Palestine AG, Chan CC. et al. Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology 1985; 92: 467-471 (Ib)
• 64 Nussenblatt RB, Palestine AG, Chan CC. et al. Randomized, double-masked study of cyclosporine compared to prednisolone in the treatment of endogenous uveitis. Am J Ophthalmol 1991; 112: 138-146 (Ib)
• 65 Ozyazgan Y, Yurdakul S, Yazici H. et al. Low dose cyclosporin a versus pulsed cyclophosphamide in Behçetʼs syndrome: a single masked trial. Br J Ophthalmol 1992; 76: 241-243 (IIa)
• 66 Patel AK, Newcomb CW, Liesegang TL. et al. Risk of retinal neovascularization in cases of uveitis. Ophthalmology 2016; 123: 646-654 (IIb)
• 67 Pacheco PA, Taylor SR, Cuchacovich MT. et al. Azathioprine in the management of autoimmune uveitis. Ocul Immunol Inflamm 2008; 16: 161-165 (III)
• 68 Pleyer U, Stübiger N. New pharmacotherapy options for noninfectious posterior uveitis. Expert Opin Biol Ther 2014; 14: 1783-1799 (IV)
• 69 Pleyer U, Klamann M, Laurent TJ. et al. Fast and successful management of Intraocular inflammation with a single Intravitreal dexamethasone implant. Ophthalmologica 2014; DOI: 10.1159/000368987.
• 70 Pleyer U, Pohlmann D, Stübiger N. Therapie der posterioren, nichtinfektiösen Uveitis – aktueller Stand und künftige Entwicklungen. Ophthalmologe 2016; 113: 380-390 (IV)
• 71 Pleyer U, Algharably EA, Feist E. et al. Small molecules as therapy for uveitis: a selected perspective of new and developing agents. Expert Opin Pharmacother 2017; 18: 1311-1323 10.1080/14656566.2017.1361408
• 72 Rathinam SR, Babu M, Thundikandy R. et al. A randomized clinical trial comparing methotrexate and mycophenolate mofetil for noninfectious uveitis. Ophthalmology 2014; 121: 1863-1870 (Ib)
• 73 http://www.rheumanet.ch/download/Content_attachments/FileBaseDoc/Steroid/2DOsteoporose/2D12/2D2013-D.pdf Stand: 26.9.2017
• 74 Roesel M, Gutfleisch M, Heinz C. et al. Intravitreal and orbital floor triamcinolone acetonide injections in non-infectious uveitis. A comparative study. Ophthalmic Res 2009; 42: 81-86 (III)
• 75 Roy M. Early clinical experience with leflunomide in uveitis. Can J Ophthalmol 2007; 42: 634 (III)
• 76 Samson CM, Waheed N, Baltatzis S. et al. Methotrexate therapy for chronic noninfectious uveitis: analysis of a case series of 160 patients. Ophthalmology 2001; 108: 1134-1139 (III)
• 77 Santos-Gomez M, Calvo-Rio V, Blanco R. et al. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behcetʼs disease: results of a multicentre open-label study. Clin Exp Rheumatol 2016; 34 (Suppl. 102) S34-S40 (IV)
• 78 Schaap-Fogler M, Amer R, Friling R. et al. Anti-TNF-α agents for refractory cystoid macular edema associated with noninfectious uveitis. Graefes Arch Clin Exp Ophthalmol 2014; 252: 633-640 (III)
• 79 Schilling H, Heiligenhaus A, Laube T. et al. Long-term effect of acetazolamide treatment of patients with uveitic chronic cystoid macular edema is limited by persisting inflammation. Retina 2005; 25: 182-188 (III)
• 80 Siepmann K, Huber M, Stubiger N. et al. Mycophenolate mofetil is a highly effective and safe immunosuppressive agent for the treatment of uveitis: a retrospective analysis of 106 patients. Graefes Arch Clin Exp Ophthalmol 2006; 244: 788-794 (III)
• 81 Suhler EB, Smith JR, Giles TR. et al. Infliximab therapy for refractory uveitis: 2-year results of a prospective trial letter. Arch Ophthalmol 2009; 127: 819-822 (Ib)
• 82 Suhler EB, Lowder CY, Goldstein DA. et al. Adalimumab therapy for refractory uveitis: results of a multicentre, open-label, prospective trial. Br J Ophthalmol 2013; 97: 481-486 (Ib)
• 83 Takeuchi M, Kezuka T, Sugita S. et al. Evaluation of the long-term efficacy and safety of infliximab treatment for uveitis in Behçetʼs disease: a multicenter study. Ophthalmology 2014; 121: 1877-1884 (IIb)
• 84 Taylor SR, Banker A, Schlaen A. et al. Intraocular methotrexate can induce extended remission in some patients in noninfectious uveitis. Retina 2013; 33: 2149-2154 (III)
• 85 Teoh SC, Hogan AC, Dick AD. et al. Mycophenolate mofetil for the treatment of uveitis. Am J Ophthalmol 2008; 146: 752-760.e3 10.1016/j.ajo.2008.03.004 (III)
• 86 The Multicenter Uveitis Steroid Treatment (MUST), Trial Follow-up Study Research Group. Benefits of systemic anti-inflammatory therapy versus fluocinolone acetonide intraocular implant for intermediate uveitis, posterior uveitis, and panuveitis. Fifty-four-month results of the Multicenter Uveitis Steroid Treatment (MUST) trail and follow-up study. Ophthalmology 2015; 122: 1967-1975 (Ib)
• 87 The Multicenter Uveitis Steroid Treatment (MUST), Trial Follow-up Study Research Group. Quality of life and risks associated with systemic anti-inflammatory therapy versus fluocinolone acetonide intraocular implant for intermediate uveitis, posterior uveitis, or panuveitis. Ophthalmology 2015; 122: 1976-1986 (Ib)
• 88 Thomas SS, Borazan N, Barroso N. et al. Comparative immunogenicity of TNF inhibitors: impact on clinical efficacy and tolerability in the management of autoimmune diseases. A systematic review and meta-analysis. BioDrugs 2015; 29: 241-258 (Ia)
• 89 Thorne JE, Jabs DA, Qazi FA. et al. Mycophenolate mofetil therapy for inflammatory eye disease. Ophthalmology 2005; 112: 1472-1477 (III)
• 90 Thorne JE, Skup M, Tundia N. et al. Direct and indirect resource use, healthcare costs and work force absence in patients with non-infectious intermediate, posterior or panuveitis. Acta Ophthalmol 2016; 94: 331-339
• 91 Udeotuk JD, Dai Y, Ying GS. et al. Risk of corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases. Ophthalmology 2012; 119: 1569-1574 (IIb)
• 92 Yates WB, Yajdic CM, Na R. et al. Malignancy risk in patients with inflammatory eye disease treated with systemic immunosuppressive therapy: a tertiary referral cohort study. Ophthalmology 2015; 122: 265-273 (IIb)
• 93 Yazici H, Pazarli H, Barnes CG. et al. A controlled trial of azathioprine in Behçetʼs syndrome. N Engl J Med 1990; 322: 281-285 (Ib)