Definition of Uveitis Refractory to Treatment: A Systematic Review in the Absence of a Consensus

Purpose To evaluate the different definition of refractoriness in uveitis in the literature. Methods We systematically searched the literature in order to identify definitions of refractory noninfectious uveitis in adult patients. A search strategy in the databases of MEDLINE and Scopus was used to find articles published between January 2005 and October 2018. Results Definitions of corticosteroids-refractoriness were related to two main concepts: persistence of inflammation despite the use of corticosteroid and recurrences above a dosage threshold. In terms of immunomodulatory therapy and biologic agents, we observed a great variety of definitions: persistence of inflammation, number of attacks, side effects or complications, symptoms, and best-corrected visual acuity. Conclusions The results of this systematic review demonstrate the current lack of consensus on the definition for refractory uveitis, regardless of the treatment being used and revealed a new terminology based on a comprehensive and operational definition for each specific category of refractoriness.

Automated summary

This review evaluates the different definitions of refractoriness in uveitis in the literature and finds a lack of consensus. Definitions of corticosteroids-refractoriness are related to persistence of inflammation and recurrences above a dosage threshold, while definitions for immunomodulatory therapy and biologic agents vary greatly.