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Review Article

Medical Management of Uveitis Current Trends

Kalpana Babu, Padmamalini Mahendradas1

Access this article onlineWebsite:

www.ijo.in

DOI:

10.4103/0301-4738.114099

PMID:

******

Quick Response Code:

Keywords:

Correspondence to:

Topical Corticosteroids

et al

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et al.,

Iontophoresis

Periocular Steroids

Intravitreal Steroids

Table 1: Commonly available topical corticosteroid

preparations

Medication Concentration (%) Formulation

Dexamethasone sodium

phosphate

Solution

Dexamethasone alcohol Suspension

Fluorometholone acetate Suspension

Fluorometholone alcohol Suspension

Loteprednol Suspension

phosphate

Solution

Suspension

Prednisolone acetate 1 Suspension

Prednisolone sodium

phosphate

Solution

Emulsion

Rimexolone 1 Suspension

Table 2: Injectable corticosteroid preparations

Medication Concentration Approximateduration of action

Dexamethasone

sodium phosphate

solution

Triamcinolone

acetonide

suspension

intraocular;

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Systemic Steroids

Table 3: Suggested guidelines for the use of prednisone for

4

Parameter Suggested guidelines

Initial dose 1 mg/kg/day

Maximum adult oral dose

Tapering schedule

Monitor

every 3 months

and annually thereafter

Supplemental therapy

agents as needed

Table 4: Outlines the adverse events of systemic

corticosteroids

Common

Moon facies

Weight gain

Fat redistribution

Increased acne

Suppression of hypothalamic pituitary axis

Infections

Diabetes mellitusFluid retention

Atherosclerosis

Osteoporosis

Easy bruising

Poor wound healing

Gastric ulcerations

Intravenous route

Ocular effects Cataract

Glaucoma/elevated intraocular pressure

Myopia

Increased susceptibility to infectionsMyopia

Central serous chorioretinopathy

Proptosis

Papilledema

Corneal/scleral thinning

Eyelid edema

Subconjunctival hemorrhage

Iris/ciliary body microcysts

Immunosuppressive Agents

3

3

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Biologics

Table 5: Immunosuppressives in uveitis

Class Generic Name Mechanism of

Action

Dose Side effects Comments

Antimetabolite

Alters purine

metabolism

1mg/kg/day initially;

day

Can be given once

daily or as divided

dose twice daily

Methotrexate

Inhibitor ofdihydrofolate

reductase

Folic acid 1mg/day

Mycophenolate

IMP dehydrogenase

inhibitor

bd

Possibly better

tolerated than

dehydrogenase

inhibition (pyrimidine

nil

Alkylating agent Cyclophosphamide

Lymphocytotoxicity

kg/day

Infertility

Can be given as iv

pulse

Chlorambucil Causing DNA to

inhibiting cell

replication and

protein synthesis

kg/day

Infection

nil

Cyclosporine

T cell inhibitor

kg/day

hyperplasia

Monitor for renal

Tacrolimus

T cell inhibitor

Diabetes

Monitor for renal

Rapamycin

cells

day

Increase susceptibility to

hyperlipidosis

intravitreal injections

can also be given

Calcineurin Inhibitor Reversible inhibitor T

cell proliferation

Colchicine

Inhibits neutrophil

chemotaxis by

inhibition microtubule

polymerisation

hyperlipidemia

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Intravenous Immunoglobulin

et al

Other Biologic Agents

et al

et al

TNF

Blockers

Biologicals

IL-Receptor

antagonist

Lymphocyte

antagonist

Others

Adalimumab

Rituximab

Intravenous

immunoglobulin

Etanercept

Alefacept

Selective T cell

Co stimulation

Abatacept

Table 7: Mechanism of action, dosage, and side effects of cytokine inhibitors

Generic Name Dosage Mechanism of action Side effects

Cytokine Inhibitors

receptor

monoclonal antibody

Autoantibodies

receptor antibody

Infection

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Adjuvant Therapy

[32]

Current Trends in Infectious UveitisManagement

et al

Conclusion

References

et al

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, et al

et al

et al

et al

et al

et al

et al

Cite this article as: Babu K, Mahendradas P. Medical Management of Uveitis

- Current Trends. Indian J Ophthalmol 2013;61:277-83.

Source of Support: Nil.

None declared.

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