Abstract Background A significant proportion of patients with inflammatory bowel disease (IBD) develop extraintestinal manifestations (EIM). Ocular involvement occurs in an estimated 12–25% of ulcerative colitis cases and 25–50% of Crohn’s disease cases, making it the third most common EIM after rheumatological and dermatological manifestations. There is limited information on treatment options for ocular EIM. To address this gap, we reviewed all systematic reviews (SRs) evaluating drug interventions for ocular EIM. Methods We searched three databases (MEDLINE, Embase, and the Cochrane Database of Systematic Reviews) from inception to May 2024 to identify SRs addressing therapeutic interventions for ocular EIM. The exclusion criteria ruled out studies that were not systematic reviews, did not focus on patients with IBD, or were unrelated to ocular interventions. Screening, selection, and data extraction were performed independently by two authors, with a third author consulted when necessary. The quality of SRs was assessed using the AMSTAR-2 tool. Results Of 1,436 studies, six met the inclusion criteria. The ocular EIMs most commonly reported included uveitis, iritis, scleritis, and episcleritis. The number of studies reporting ocular EIM within each SR varied from two (Guillo, 2021) to 22 (Peyrin-Biroulet, 2017). Therapeutic interventions differed: two SRs evaluated vedolizumab (Zheng, 2024; Chateau, 2019), one focused on ustekinumab (Guillo, 2021), while the others assessed different advanced therapies. Quality assessment using AMSTAR-2 rated the reviews from high to low confidence, with most achieving moderate confidence due to some non-critical weaknesses. The incidence of new ocular EIM after treatment was 1% for both vedolizumab and ustekinumab in two SRs. For existing EIM, ocular symptoms improved in 55–59% of cases with ustekinumab (data from two SRs). However, there was no consistent evidence supporting vedolizumab for treating established ocular EIM. Anti-tumor necrosis factor (TNF) drugs were evaluated in two SRs, showing benefits for most patients with ocular manifestations without notable differences in the effectiveness among the different anti-TNF agents. No SRs focused on the risk of new ocular EIM after starting anti-TNF therapy. Conclusion Infliximab, adalimumab, certolizumab and ustekinumab appear effective for ocular EIM. There is no strong evidence that vedolizumab is effective for treating existing ocular EIM, though it may reduce the occurrence of new EIM. Further research with clear definitions and systematic assessments of ocular manifestations is needed. A multidisciplinary approach remains crucial. References Licona Vera E, Betancur Vasquez C, Peinado Acevedo JS, Rivera Bustamante T, Martinez Redondo JM. Ocular Manifestations of Inflammatory Bowel Disease. Cureus. 2023;15(6):e40299
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