Medication Used in the Treatment of Uveitis

WHICH DRUGS ARE USED IN THE TREATMENT OF UVEITIS?

Uveitis of isolated or idiopathic type or accompanied by systemic disorders is taken into a treatment program upon detailed evaluation.  For example, a patient who has developed uveitis due to a tuberculosis infection should be given a treatment for both conditions. 

• Corticosteroids: Patients with isolated anterior uveitis are generally given corticosteroid-containing eyedrops and sometimes pomades, whereas patients with posterior uveitis or panuveitis are given systemic corticosteroids. On the other hand, corticosteroid injection at the periphery of the eye is a suitable treatment model in those patients who are not on systemic corticosteroids, who have unilateral involvement, pars planitis or have developed macular edema in the follow-up of the disease. Corticosteroid therapy should not be suddenly stopped, instead it should be reduced over time in consideration of the severity of the disease and its exacerbation, and continued in a physiologic dose. Corticosteroids involve serious side effects.
• Drugs suppressing or regulating the immune system (azathioprine, cyclosporine A, cyclophosphamide and interferon): Immunosuppressive drugs are used singly or in combination in patients with posterior uveitis or panuveitis depending on the severity of involvement and frequency of attacks. In such patients, in addition to the ongoing planned use of such drugs, systemic corticosteroids may also be used from time to time in new exacerbations that are particularly threatening towards vision. 
• Others: In anterior uveitis, in addition to corticosteroid eye drops, pupil-dilating eye drops can also be used in order to prevent sticking and alleviate the pain around the eye.  Colchicine and thalidomide are also used occasionally. There are ongoing studies about etanercept and remicade which have recently been in use.

WHAT ARE THE CHARACERISTICS AND SIDE EFFECTS OF THESE DRUGS?

Every drug has one or several side effect(s). Blood tests performed on patients in regular follow-up enable control on such side effects. Corticosteroids involve the side effects of change in the body fat distribution, chapping on the skin, effects on the digestive, skeletal and cardiovascular systems as well as the ocular risk of glaucoma and cataract development. Cyclosporine A involves side effects on the kidneys and the cardiovascular system whereas azathioprine affects the bone marrow and the liver. 

WHAT SHOULD PATIENTS ON DRUGS BE CAREFUL ABOUT?

Upon prescription of such medication, patients should be thoroughly informed, and tests for following up side effects should be requested. Further, patients are expected to carefully adhere to their physicians’ advice and regularly attend follow-ups. In addition, irregular use or abrupt interruption of such drugs may lead to uveitis attacks, therefore patients should be careful about regular use.

HOW LONG DOES DRUG THERAPY LAST?

The medication used in the treatment suppress the symptoms of inflammation but do not directly treat the disease. Therefore, good treatment planning is crucial and the medication should be used for a reasonable period according to the protocol established by the physician. In some specific uveitis types, follow-up without treatment is also possible.

IN WHICH CASES IS OPHTHALMOLOGIC SURGERY ADVISABLE?

Eyes with uveitis may develop certain complications in time due to the condition itself or the medication used in its treatment. Cataract is one of such complications, the treatment of which entails surgery. Other than some specific uveitis types, the surgery typically involves implanting an intraocular lens. It may become necessary to perform vitrectomy on patients with persisting intravitreous hemorrhage induced by the formation of new vessels, condensation in the vitreous due to intense inflammatory response and dense cystoid macular edema with no positive response to medication therapy.