Biologic Therapy in Refractory Non-Infectious Uveitis: An Analysis of 60 Cases at a Tertiary Eye Care Centre from South India

PURPOSE: To evaluate the effectiveness and safety of biologic therapy in patients with refractory non-infectious uveitis (NIU) in a real-world clinical setting. METHODS: A retrospective observational study was conducted at a tertiary eye care centre in South India between 2022 and 2025. Patients diagnosed with NIU, who were not responding to conventional treatment and had received biologics during this period, were included. Demographic details, anatomical classification, etiological diagnosis, type of biologic used, treatment duration, clinical outcomes, and adverse events were analysed. RESULTS: A total of 60 patients with refractory NIU receiving biologic therapy were included. The mean age at biologic initiation was 23.1 ± 13.7 years, comprising 27 (45%) paediatric and 33 (55%) adults. The mean duration of uveitis prior to biologic initiation was 34.48 ± 52.36 months. Anterior uveitis was the most common (40%). Autoimmune etiologies predominated, with juvenile idiopathic arthritis-associated uveitis (28.3%), HLA-B27-associated uveitis (23.3%), and Behçet disease (20%). Adalimumab was the most frequently used biologic agent (88.3%) followed by Infliximab (5%), golimumab (3.3%) and tocilizumab (3.3%). Biologic therapy resulted in significant control of intraocular inflammation (p < 0.0001). Visual acuity remained stable throughout the follow-up. Treatment modification was required in 7 patients (11.7%). Side effects were observed in 3 (5%) patients, 2 (3.3%) showed inadequate response and 2 patients (3.3%) discontinued biologics due to financial constraints. CONCLUSION: Biologic therapy is an effective and safe therapy for refractory non-infectious uveitis across all age-groups and etiologies. Early escalation to biologics may help arrest long-term cumulative inflammatory damage and preserve visual function by sustained inflammatory control.