Systemic Management

Systemic treatment often requires a collaborative team approach. Nonsteroidal anti-inflammatory drugs, antimalarials (hydroxychloroquine), systemic corticosteroids, immunosuppressive therapy, and biologics may be effective. Systemic corticosteroids are used in the acute stage, and nonsteroidal anti-inflammatory drugs and hydroxychloroquine are used in mild patients. A variety of immunosuppressive agents have demonstrated efficacy in ocular SLE including methotrexate, mycophenolate mofetil, azathioprine, and cyclophosphamide (Palejwala et al. 2012; Silpa-archa et al. 2016). Biologics targeting cytokines, B and T lymphocytes, and B-cell-activating factors are also considered in patients refractory to other treatment. Belimumab is the first biologic agent approved by the Federal Drug Administration in 2011 for SLE, which inactivates B-cell-activating factor (Dooley et al. 2013; Navarra et al. 2011; Touma et al. 2013). Others include rituximab, epratuzumab, sifalimumab, and ocrelizumab.

Local Therapy

Local treatment according to the specific pathology along with systemic treatment may play a role in the treatment. For vascular occlusion and ischemia, laser photocoagulation can be used (Fig. 13.4). Vitrectomy may be performed for complicated neovascularization such as vitreous hemorrhage and tractional retinal detachment. Intravitreal anti-VEGF injection has also been reported as an effective therapy for vaso-occlusion and vasculitis in SLE (Kurup et al. 2009; Lee et al. 2013).