In most intraocular inflammations and uveitis syndromes, immunological mechanisms play an important role in the etiology and disease process.One of the most important immunological factors of various intraocular inflammatory conditions is cytokines. Cytokines in large part mediate intercellular communication as well as upregulate or downregulate immune reaction. Among the T helper cells, Th1 cells produce interleukin(IL)- 2 and interferon gamma, whereas Th2 cells produce IL-4, IL-5, IL-6, and IL-13. Abnormal production and function of these cytokines often induce intraocular inflammatory conditions such as uveitis or retinal vasculitis. Therefore, cytokine therapy or anti-cytokine therapy may be a new important treatment strategy for various difficult intraocular inflammations and uveitis syndromes. As an example of anti-cytokine therapy, we have tried anti-TNF-alpha therapy by intravenous injection of infliximab in cicloporin-resintant severe patients with Behcet乫s disease. Infliximab was shown to be quite
effective, and recurrent uveoretinitis attacks disappeared during the therapy. Intraocular insertion of corticosteroid implant seems to be another new chice for the treatment of recurrent intraocular inflammations, sometimes with choronic cystoid macular edema. Adacolumn apheresis may be
another new possibility. Adacolumn selectively adsorbs granulocytes and monocytes from the peripheral blood of the patients. This apheresis is known to suppress the proinflammatory cytokines with minimal adverse reactions. In this presentation, possible new treatments in various intraocular inlflammatory diseases will be discussed.