Asad F. Durrani, MD
Wills Eye Hospital
During Uveitis and Ocular Tumors session of Macula 2023, world experts in the fields of uveitis and ocular oncology shared the latest developments in the diagnosis and management of these challenging diseases.
First, Dr. James P. Dunn (Wills Eye Hospital) gave an excellent talk on when to initiate immunosuppression in uveitis patients. Immunosuppression should be considered in those who are poor candidates for steroids due to systemic comorbidities, fail to respond to high dose steroids, experience intolerable side effects, have incomplete control on low-dose steroid, and children. A variety of agents are available for use, but most importantly, treatment with immunosuppressive agents requires buy-in from the patient and appropriate follow-up with various imaging modalities by the treating physician.
Next, Dr. Meghan Berkenstock (Johns Hopkins University) presented data on the use of suprachoroidal triamcinolone from the PEACHTREE, MAGNOLIA, and AZALEA studies. These studies showed that this novel delivery method was safe and effective for the treatment of macula edema secondary to non-infectious uveitis, a common cause of vision loss in patients with uveitis.
Keeping with the theme of uveitic macular edema, Dr. Douglas Jabs (Johns Hopkins University) presented results from the MERIT trial, comparing the efficacy of intravitreal dexamethasone, intravitreal methotrexate, and intravitreal ranibizumab for the treatment of persistent or recurrent uveitic macular edema. The study results demonstrated that intravitreal dexamethasone improved central subfield thickness and vision at 12 weeks, whereas no improvement was noted with intravitreal methotrexate or ranibizumab.
Switching gears to oncology, Dr. Jasmine Francis (Memorial Sloan Kettering Cancer Center) gave an excellent overview of the ocular side effects of cancer drugs. BRAF inhibitors can cause bilateral non-granulomatous anterior uveitis in 4.5% of patients. MAP kinase inhibitors can cause maculopathy with subretinal fluid in up to 15% of patients. Finally, checkpoint inhibitors can cause inflammation in every layer of the eye. As the use of these novel lifesaving medications increases, retinal specialists will encounter more and more of these patients in their practices.
Next, Dr. Carol Shields (Wills Eye Hospital) gave an exciting talk on upcoming advancements in the field of uveal melanoma. A new focal therapy, Aura-011, utilizes nanoparticles that specifically bind melanoma cells and allows for targeted laser treatment of tumors. New systemic therapies such as tebentafusp and darovasertib are on the horizon and there is also work underway to develop a liquid biopsy for uveal melanoma. The future of ocular oncology is bright!
Finally, Dr. Jose Pulido (Wills Eye Hospital) gave an interesting talk on oncology immunogenicity. In collaboration with the Mayo Clinic, his team is utilizing viruses and changing the epitopeome of tumor cells to fight cancer. The overarching theme of his talk was that more work needs to be done to increase the immunogenicity of tumor cells in order to activate the patient’s own immune system to destroy tumors.
The session concluded with a lively discussion between the panelists as challenging cases were presented.