Reduced rates of intraocular surgeries in anterior uveitis

Autoimmune uveitis is a relatively common disease with multiple aetiologies. Chronic intraocular inflammation can lead to both structural and functional damage in the eye. The aim of this registry-based study was to examine changes in antirheumatic treatment practices for uveitis at the TAYS Eye Centre in Finland and to evaluate whether systemic antirheumatic therapy has had a measurable impact on the need for intraocular surgery in patients with anterior uveitis. We evaluated the annual number of patients with anterior uveitis treated with antirheumatic drugs prescribed by ophthalmologists in the Tays Eye Centre service area in Pirkanmaa from 2019 to 2024. In addition, we assessed the frequency of cataract and glaucoma surgeries performed in these patients during the same period. The antirheumatic treatments were downloaded from Social Insurance Institution's publicly available database (https://tietotarjotin.fi). We searched for the following treatments: methotrexate, mycophenolic acid, azathioprine, and subcutaneous tumour necrosis alpha inhibitor (TNFi) treatment (adalimumab or other monoclonal TNFi). We requested a search of the electronic database of Tampere University Hospital to find the number of intraocular surgeries in patients with a diagnostic code H20 for anterior uveitis. Between 2019 and 2024, the number of patients diagnosed with uveitis in the TAYS Eye Centre region increased from 1070 to 1235. During the same period, the number of uveitis patients treated with methotrexate rose by 150%, from 72 to 181. Mycophenolic acid was introduced as a treatment option for uveitis at the TAYS Eye Centre in 2020, and by 2024, it had been prescribed to 60 patients, making it the third most used antirheumatic agent. The use of TNF inhibitors also increased substantially, from 10 patients in 2019 to 92 patients in 2024 (Table 1). Although the annual number of cataract surgeries increased from 40 to 57 between 2019 and 2022, the number began to decline after this peak. During the subsequent 2 years, the number of surgeries decreased markedly, reaching 9 procedures in 2024. While the number of glaucoma surgeries was relatively low in 2019 (13 surgeries), the trend continued to decline, reaching 4 surgeries in 2024 (Table 1). Our data demonstrate a clear trend toward a reduced need for surgery following the initiation of long-term systemic therapy. We show a substantial increase in both the number of uveitis patients and the use of antirheumatic medications during the study period, while the need for cataract and glaucoma surgeries in this patient group has declined concurrently (Table 1). Similar observations have been reported in the MUST trial (Jabs et al., 2023) and by Wennink et al. (2022). Although the antirheumatic medications investigated in this study were originally developed for rheumatologic conditions, they also modulate immune pathways relevant to uveitis. The decreased need for surgical interventions for complications may stem from reduced use of corticosteroids and improved control of intraocular inflammation—both of which are well known to elevate intraocular pressure and accelerate cataract formation (Papaliodis et al., 2023) (Sallam et al., 2009). Our findings indicate favourable outcomes among uveitis patients receiving these therapies and highlight the potential value of early initiation of systemic antirheumatic treatment in chronic or relapsing disease. We acknowledge, however, that our data more strongly reflect the use of non-biologic antirheumatic drugs than biologics. Taken together, these observations underscore the need for further research into both established and emerging immunomodulatory strategies for the treatment of uveitis. Ethical committee approval was not acquired for the medication data as the data is freely available online. For the surgeries, ethical approval R25769 was received from ethical committee of Pirkanmaa Well-Being Services.