Expert opinion on the management and follow-up of uveitis patients during SARS-CoV-2 outbreak

Expert Rev Clin Immunol. 2020 Jul;16(7):651-657. doi: 10.1080/1744666X.2020.1791086. Epub 2020 Jul 21.

Abstract

Introduction: Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require particular attention because of their theoretical risk of viral infection, in the context of therapeutic immunosuppression.

Areas covered: This collaborative work proposes practical management and follow-up criteria for uveitis patients in the context of the ongoing SARS-CoV-2 pandemic.

Expert opinion: Management should proceed as usual when access to health care possible in patients who do not belong to a group at high risk of severe SARS-CoV-2 infection, and in uncontrolled uveitis cases. In case of reduced access to eye clinics or high risk of SARS-CoV-2 infection, patients' management should be stratified based on their clinical presentation. In non-severe uveitis cases, the use of systemic steroids should be avoided, and local steroids preferred whenever possible. In uncontrolled situations where there is real risk of permanent visual loss, high-dose intravenous steroids and/or systemic immunosuppressants and/or biotherapies can be administered depending on the severity of eye disease. Immunosuppressive therapy should not be withheld, unless the patient develops SARS-CoV2 infection.

Keywords: SARS-CoV-2; Uveitis; biologics; coronavirus; corticosteroid; immunosuppression; immunosuppressive therapy; intravitreous injection; management.

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections*
  • Humans
  • Immunocompromised Host*
  • Pandemics*
  • Pneumonia, Viral*
  • Risk Factors
  • SARS-CoV-2
  • Uveitis* / drug therapy