The 21st century may be remembered as the true golden age of medicine. Advances in molecular biology, immunology, pharmacology, and drug discovery that began and matured over the last 50 years will lead to substantive changes in the way we diagnose and treat our patients with uveitis in the decades to come. Prior to 1950, treatment for uveitis was severely limited. Many physicians treated patients with uveitis by inducing hyperpyrexia. Patients were placed into steam baths where their temperatures were raised to 40 to 41 degrees centigrade for four to six hours. Although occasionally successful, Sir Stewart Duke-Elder did note that the treatment was poorly tolerated and often dangerous for the patient. In 1949 Philip Hench and colleagues reported the successful use of corticosteroids for the treatment of rheumatoid arthritis. Ophthalmologists were quick to use corticosteroids for the treatment of ocular inflammatory disease, and interestingly, despite profound improvements in immunotherapy, steroids remain the mainstay of therapy even today.
However, many patients remain resistant or become intolerant to corticosteroid therapy. Spawned by the need for better immunosuppression for transplant surgery, a number of new and effective immunosuppressive agents have been developed. More recently, a number of novel immunologic therapies have aided physicians in the treatment of autoimmune disease. Drugs that specifically target cytokines and cytokine receptors are now commonly used in the treatment of diseases such as rheumatoid arthritis and increasingly employed in the treatment of severe uveitis. Intravitreal injections and sustained-release intravitreal implants have allowed physicians to deliver high amounts of drugs to target tissues in the eye while avoiding systemic side effects. Nevertheless, the cause of many forms of uveitis remains unknown, and vision loss is still an all too common occurrence in our patients.
Even since the publication of the third edition of our book, there have been a number of significant advances in basic science, technology, and clinical medicine that impact our approach to uveitis. First, the field of immunology continues to move forward. New cytokines and inflammatory pathways have led to a better understanding of disease pathogenesis and novel therapeutic targets. The roles of IL-23 and Th17 cells in autoimmune disease and uveitis have been described and new therapies are being developed that target this pathway. Second, new technologies are changing the way we diagnose and follow our patients. Ocular coherence tomography is now commonly used to evaluate macular edema and assess the response to therapy. PCR is more frequently used to diagnose infectious etiologies for uveitis and allow specific antimicrobial therapy for patients who were previously misdiagnosed. Third, we have new therapies in our armamentaria, including novel immunosuppressive agents and biologics that target key inflammatory cytokines, cell adhesion molecules, inflammatory cells, or other critical components of the inflammatory response. Fourth, advances in drug delivery allow us to administer high amounts of drugs directly to the diseased tissues and minimize systemic exposure and treatment-limiting side effects.
The goal of this fourth edition of Uveitis: Fundamentals and Clinical Practice remains the same as that of the first three – to provide a comprehensive text presenting a practical approach to the diagnosis and treatment of various forms of the disease. The book includes a review of the fundamentals of ocular immunology but focuses on the clinical aspects of the disease. We believe that our book will be of value not only to ophthalmologists, optometrists, and other eye care providers, but also to internists, rheumatologists, and other physicians who see patients with diseases associated with uveitis.
Again, the text is divided into five parts. Part 1 includes a single chapter on the immunology of uveitis. Part 2 on diagnosis includes detailed discussion of the medical history, clinical examination, and diagnostic testing in the patient with uveitis. Part 3 includes two chapters covering the medical and surgical therapy of uveitis. In Part 4, uveitic syndromes with known infectious etiologies are reviewed. In Part 5, a number of other uveitic diseases and syndromes are included – some which may have an infectious etiology that has not been elucidated. With improvements in our diagnostic testing, we are identfying specific infections as the cause for more forms of uveitis. We now know that Tropheryma whipllei causes Whipple's disease, and the section on uveitis associated with this disease has now been moved from the chapter on anterior uveitis to the chapter on bacterial and fungal diseases. Finally, we have added a chapter on the role of inflammation in diseases other than uveitis, including macular degeneration.
We have based this book, to a large extent, on our clinical experience, both at the National Eye Institute where both of us spent time seeing patients together, and at the Jules Stein Eye Institute. We owe a great deal of thanks to Alan Palestine who helped make the first edition of the book a reality and continue to express our gratitude to Chi-Chao Chan, Igal Gery, and Rachel Caspi for their knowledge and friendship and to our fellows for their inquisitiveness and comradeship. We must also thank the photographers of the National Eye Institute and a number of our colleagues for obtaining the artful clinical photographs. Importantly, we must thank our patients who value the opportunity to contribute to the understanding of their disease in an attempt to help others.
Robert B. Nussenblatt, MD and Scott M. Whitcup
Key Features
- Covers the medical, pharmacological, and surgical treatment of uveitis to serve as a complete overview of all uveitis related information.
- Features multiple chapters on diagnostic approach to help you overcome challenges in making accurate diagnoses.
- Provides additional information on inflammatory eye diseases in chapters on scleritis, masquerade syndromes, and the role of inflammation in other ocular diseases for more comprehensive coverage.
- Includes illustrated case studies to supplement major clinical points and provide insight into real situations that you can apply in practice.
- Highlights important information in key points boxes that make it easy to locate crucial points on each topic.
Website Features
- Consult the book from any computer at home, in your office, or at any practice location.
- Instantly locate the answers to your clinical questions via a simple search query.
- Quickly find out more about any bibliographical citation by linking to its MEDLINE abstract.
New to this edition
- Includes access to the fully searchable text online at expertconsult.com.
- Features significant updates to the chapters on the role of surgery in the patient with uveitis, acquired immune deficiency syndrome, anterior uveitis, white dot syndromes, and masquerade syndromes.
- Covers advancements and new developments on all aspects of uveitis including new medical and surgical treatments.
- Presents photographs in full color to better prepare you for actual clinical diagnosis.
PART 1 - Fundamentals
- Chapter 1 - Elements of the Immune System and Concepts of Intraocular Inflammatory Disease Pathogenesis
PART 2 - Diagnosis
- Chapter 2 - Medical History in the Patient with Uveitis
- Chapter 3 - Examination of the Patient with Uveitis
- Chapter 4 - Development of a Differential Diagnosis
- Chapter 5 - Diagnostic Testing
- Chapter 6 - Evidence-Based Medicine in Uveitis
- Chapter 7 - Philosophy, Goals, and Approaches to Medical Therapy
- Chapter 8 - Role of Surgery in the Patient with Uveitis
PART 4 - Infectious uveitic conditions
- Chapter 9 - Bacterial and Fungal Diseases
- Chapter 10 - Spirochetal Diseases
- Chapter 11 - Acquired Immunodeficiency Syndrome
- Chapter 12 - Acute Retinal Necrosis and Progressive Outer Retinal Necrosis
- Chapter 13 - Other Viral Diseases
- Chapter 14 - Ocular Toxoplasmosis
- Chapter 15 - Ocular Histoplasmosis
- Chapter 16 - Toxocara canis
- Chapter 17 - Onchocerciasis and Other Parasitic Diseases
- Chapter 18 - Postsurgical Uveitis
PART 5 - Uveitic conditions not caused by active infection
- Chapter 19 - Anterior Uveitis
- Chapter 20 - Scleritis
- Chapter 21 - Intermediate Uveitis
- Chapter 22 - Sarcoidosis
- Chapter 23 - Sympathetic Ophthalmia
- Chapter 24 - Vogt–Koyanagi–Harada Syndrome
- Chapter 25 - Birdshot Retinochoroidopathy
- Chapter 26 - Behcet's Disease
- Chapter 27 - Retinal Vasculitis
- Chapter 28 - Serpiginous Choroidopathy
- Chapter 29 - White-Dot Syndromes
- Chapter 30 - Masquerade Syndromes
- Chapter 31 - Other Ocular Disorders and the Immune Response: Who Would Have Thought?
Product Details
- Hardcover: 480 pages
- Publisher: Mosby; 4 edition (April 6, 2010)
- Language: English
- ISBN-10: 1437706673
- ISBN-13: 978-1437706673
List Price: $195.00