Editorial :
Medical and Surgical Complexity in Uveitis

		The treatment of ocular inflammation is perhaps unique in medicine for the combination of surgical and medical management of the same disease by the same medical specialist. If there is such a thing as a complete uveitis specialist, that physician and surgeon would control inflammation with medication applied systemically, topically, or intraocularly ranging essentially from aspirin to chemotherapy, with incursions into biological agents of the most sophisticated type, utilizing implantable drug delivery devices that exceed the safety and efficacy of those available for other organ systems and resorting to advanced surgical
Janet Davis, MD President, American Uveitis Society Professor, Bascom Palmer Eye Institute, Miami FL USA
techniques for the correction of sight-threatening disease-related complications. We are uniquely favored by pharmacologic advances in medication for our treatments and by technological improvements in instrumentation for our surgeries. The small size of the eye, usually considered a detriment, suddenly becomes a huge advantage. It is not lacking in biologic complexity, but it is a complexity that seems manageable. We have almost total control of what we know how to treat, without reliance on other specialists. The ability to do so much creates an obligation to know an equivalent amount. What is sometimes lacking in a physician’s preparation to deal with ocular inflammation is not so much technical competency in cataract surgery, for example, or vitrectomy, but the judgment to sequence treatments in a logical manner to achieve the best results. Postoperative inflammation can destroy a beautiful surgical result, suboptimal medical treatment can create the need for surgical interventions which all would rather avoid. The proficient, non-specialist ophthalmologist who occasionally encounters a challenging patient with ocular inflammation may be left at a loss while making treatment plans. There is diagnostic uncertainty, a large range of possible therapies, and, unfortunately, scientific uncertainty about many of the choices because the low numbers of patients make it difficult to acquire much information through randomized clinical trials. It is perhaps the uncertainty of uveitis care that has made international cooperation between specialists so important. The experience in Saudi Arabia is different than that in San Francisco. Japan differs from Switzerland. Intravenous immunoglobulin can be used in France and is extremely expensive and restricted in the United States. The subtle regional variations or the migration of what is rare in one part of the world to extremely rare in another is what makes personal communications of clinical experience so useful and so interesting. Inflammatory cases fill up the Grand Rounds in my institution because they are 1) complex, 2) visually significant, and 3) intriguing. Attendees at the IOIS conference in Paris 2007 should be able to experience the same excitement that a great case of undiagnosed ocular calamity inspires in any ophthalmologist, as well as to categorize the defined uveitis entities, summarize the available scientific data, and formulate targeted treatment plans that call on the entire range of ophthalmologic medical and surgical skills. The major uveitis societies of the world are participating in the meeting. It is not a satellite, but the main event. It will provide a review, an update, and a call for future research. For ophthalmologists wishing to demystify uveitis, it is a seminal meeting of immense value. Please join IOIS President, Professor Phuc LeHoang, and other distinguished members of the international uveitis community in Paris in 2007 for the biannual meeting of the International Ocular Inflammation Society.