To describe the potential role of adrenocorticotropic hormone (ACTH) gel treatment in patients with chronic non-infectious uveitis. We report the clinical course of three patients with bilateral, non-infectious anterior and intermediate uveitis, treated with ACTH gel for ≥12 months. All three patients had chronic and steroid-dependent ocular inflammation with subsequent development of ocular complications. Twice-weekly treatment with subcutaneous 80 unit/day ACTH gel was administered, and clinical outcome measures were observed. After a mean period of 14 months, all patients demonstrated significant improvement in disease activity, stable visual acuity, and an absence of side effects. Systemic steroids dosage was successfully reduced from a mean dose of 16 mg/day upon the initiation of ACTH gel treatment to 2 mg/day at last follow up. Subcutaneous ACTH gel has shown to be a safe and effective therapy in the management of non-infectious uveitis. Specifically, ACTH gel plays a role in refractory and steroid-dependent cases and in those who do not respond to or are unable to tolerate other immunomodulatory therapies.

Behçet disease (BD) is a multisystemic disease that commonly involves the eyes. Although it affects patients in all age groups, data on ocular disease by age of onset are limited. This retrospective, multicenter study aimed to compare epidemiology, systemic and ocular manifestations, treatments and outcomes between three age groups: juvenile (<18 years), adult (18–39 years) and late (≥40 years) disease onset. The study included 175 ocular BD patients (303 eyes) from Israel and Palestine: juvenile-onset (n = 25, 14.3%), adult-onset (n = 120, 68.6%) and late-onset (n = 30, 17.1%). Most patients in all groups were male. Systemic manifestations were similar in all groups. Systemic co-morbidities were more common in late-onset patients. Bilateral panuveitis was the most common ocular manifestation in all patients. Non-occlusive retinal vasculitis, peripheral vessel occlusions, cataract and elevated intraocular pressure were found more commonly among juvenile-onset eyes. Anterior uveitis and macular ischemia were most common among late-onset eyes, while branch retinal vein occlusion was most common in adult and late-onset eyes. All patients were treated with corticosteroids. Methotrexate, immunomodulatory combinations and biologic treatments were more commonly used for juvenile-onset patients. All groups had a similar visual outcome. Our study showed that patients with ocular BD have varied ocular manifestations and require different treatments according to age of disease onset, but visual outcome is similar.

To determine whether the addition of an unbiased test, metagenomic sequencing of intraocular fluid, compared to standard-of-care diagnostics alone, leads to better patient outcomes in presumed infectious intraocular inflammatory eye diseases. A randomized controlled trial was conducted from May 2022 through February 2024. Eligible participants had intraocular inflammation concerning for an infectious etiology, were 18 years or older, and had vision better than no light perception (NLP). This study enrolled participants at 6 tertiary referral eye centers in the United States (5 sites) and Thailand (1 site). Participants were randomized to have their physician have access to deep sequencing results or not. The main outcomes were (1) clinical improvement on examination at 4 weeks after randomization and (2) appropriate therapy administered by the treating physician as determined by an independent expert panel. Among the 100 participants enrolled (median [IQR] age, 62.0 [47.5-71.0] years; 57 [57.0%] were women), 92 participants completed the study. Forty-one (41.0%) participants had resolution of inflammation at their 2-week follow-up and 23 (23.0%) participants had a pathogen identified with routine diagnostics and exited the study. Twenty-one (21.0%) participants met the criteria for randomization. At the primary endpoint, 8 (88.9%) patients in the metagenomic sequencing group had clinical improvement compared to 7 (63.6%) patients in the no metagenomic sequencing group (risk difference, 30% [95% CI: 0.6%-59.1%]; relative risk [RR] = 1.35 [95% CI: 1.01-1.81]; P = 0.045). Eight (88.9%) patients were considered to receive the appropriate therapy in the metagenomic sequencing group compared to 11 (100%) patients in the no metagenomic sequencing group (risk difference, -12.0% [95% CI: -38.0%-14.0%]; RR = 0.89 [95% CI: 0.68-1.15]; P = .37). There were 3 nonstudy related adverse events. Having access to metagenomic sequencing results modestly improved clinical outcomes in a subset of patients with suspected intraocular infections. Larger studies are needed to determine the long-term impact on management and clinical outcomes. https://clinicaltrials.gov/ct2/show/NCT05286203.