Practical Manual of Intraocular Inflammation

Book Preface

There are many excellent examples of reference textbooks covering the bewildering clinical spectrum and complexity of the diagnosis and management of uveitis disorders. When faced with the uveitis patient in clinic, however, patients rarely present as per textbook diagnosis. So the challenge of uveitis requires a systematic approach to clinical assessment and interpretation of investigations to arrive at a management pathway suitable for that patient. This requires an ability to distinguish between infectious and noninfectious causes and the skill to recognize sight-threatening posterior segment inflammation. Alongside, there is a need to diagnose specific uveitic conditions and their association, or otherwise, with systemic disease for appropriate treatment in the longer term and being able to gauge an overall prognosis.

The purpose of this book is, therefore, by no means to compete with the excellent reference texts currently available, or the update texts that are frequently published and that hone in on specific cutting-edge overviews of specific aspects of uveitis. We rather wished to convey a book to complement such works. We feel there is a need to deliver a handbook that can provide a simplified synopsis of the more sight threatening uveitis conditions, better termed posterior segment intraocular inflammatory disease. A book to fit in the pocket, keep handy in the briefcase, or sit on the office desk and help in the daily task of treating uveitis patients. As such, the book aims to deliver a background to and context of the clinical problems we face in managing patients with uveitis and systematically cover a practical approach to the management of the patient in clinic, while introducing treatment algorithms. We also show where we believe part of the future lies as a result of our increased understanding of the pathogenic mechanisms of disease alongside the explosion of specific immune therapies being developed for clinical use.

Given the increase in the pharmacopoeias available and the increasingly robust evidence of their clinical efficacy, the delivery of “optimal” care remains challenging. To address some of the difficulties, we hope the book will assist training courses and modules/fellowships in ocular inflammation/uveitis available worldwide. In addition, dedicated accredited specialist training in medical ophthalmology, such as provided by the Royal College of Physicians in the United Kingdom, includes core training in uveitis and is breeding a new cadre of ophthalmic physicians specially trained in the diagnosis and management of ocular inflammatory diseases. We hope that the book will highlight an optimal approach as encouraged by specific training to generate recognized competence in both the diagnosis and monitoring of disease. This avoids the less definitive practice in which the institution and monitoring of the medical therapy is devolved to the internist or rheumatologist who may be less well placed to recognize improvement or worsening in the ocular condition, and so overall there is an arguable tendency never to achieve adequate control of ocular inflammation.

We dedicate the book to the memory of Professor Tetsuo Hida (1948–2008), Chairman of the Department of Ophthalmology, Kyorin University School of Medicine. Professor Hida was a world-renown vitreoretinal surgeon and pastpresident of the Japanese Ophthalmological Society. He will be remembered by a generation of young Japanese ophthalmologists who were fortunate enough to be graced by his knowledge, wisdom, and generosity.