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EW RETINA April 2011 49 munomodulators are in the right dose, are the right type, and that they are, in fact, setting the stage for the re-education of the immune sys- tem," Dr. Foster said. "We have a tremendous number of various types of uveitis that are outright cured—in remission, off steroids, on immuno- suppressants for a finite period. The immunosuppressants are then ta- pered and withdrawn, and 5-10 years later, the patients are still with- out any evidence of recurrence of uveitis. It's like in cancer: You get to 5 years, and you have to call that a cure." A whole panoply of im- munomodulators is available, ac- cording to Dr. Foster. Those include antimetabolites such as methotrexate, mycopheno- late mofetil, and azathioprine; cal- cineurin inhibitors such as cyclosporine, tacrolimus, and sirolimus; and alkylating drugs such as cyclophosphamide and chloram- bucil. Another category of im- munomodulatory drugs is a class called biologic response modifiers, or biologics, including anakinra, eculizumab, rituximab, infliximab, and adalimumab. There are drugs in the pipeline, such as Interleukin-17, that inhibit the other molecules important in in- flammation, Dr. Foster said. "In general, if you pluck an arrow out of your quiver to shoot at the inflammatory problem, no mat- ter what arrow you pick or what drug you choose, there's about a 70% chance that the drug is going to be the salvation of that particular patient," Dr. Foster said. "It's going to fix the problem—no muss, no fuss, no need for anything more. Keep patients on it for 2 years and you're home free." It's OK to move along if one of these drugs isn't working, he added. Co-management Comprehensive ophthalmologists shouldn't feel pressured to know every immunosuppressive drug available to patients. Instead, they should work on developing and maintaining co-management rela- tionships with doctors who do. Partner with a hematologist or rheumatologist, Dr. Foster advised. "They're very collaborative and collegial," he said. "It's important to feel comfortable in the co-manage- ment of the patient." EW Editors' note: Dr. Foster has no finan- cial interests related to his comments. Contact information Foster: 617-621-6377, sfoster@mersi.us The Matterhorn, Wallis, Switzerland See the beauty! ADVANCED TO THE MAXIMUM The new FEMTO LDV Crystal Line for Z-LASIK and corneal surgery Engineered in Switzerland Ziemer Ophthalmic Systems AG a Ziemer Group Company Allmendstrasse 11, 2562 Port, Switzerland Z-LASIK, the obvious choice. www.ziemergroup.com he t e e S ! y t u a be he K a I S A L - r Z o f M E w F e e n h T E M H O T T N A VA D A e g r l su a e n r d co n K a l Li a t s y r V C D O L T M U M I X A E M D E C y r e e n l Li M U K a I S A L r Z o f r g er m e i z . w w w he ob , t K I S A L - Z e g r l su a e n r d co n K a m o c . p ou r . e c i ho s c u o i v he ob y r e Allmendstrasse , 2562 Port, Switzerland 1 1 Allmendstrasse a Ziemer Group Company phthalmic Systems AG O Ziemer

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