Practical approach to the use of corticosteroids in patients with uveitisa,b

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Abstract

Corticosteroids constitute the first line of therapy for patients with noninfectious ocular inflammatory disease. We review factors contributing to the clinical effectiveness of various corticosteroid preparations in patients with uveitis and discuss practical aspects regarding treatment indications, when to administer various agents, and how best to dose and monitor for both treatment and adverse effects. Topically administered corticosteroids are typically indicated for the treatment of anterior uveitis, whereas periocular or intravitreal agents are employed most often in the management of intermediate or posterior intraocular inflammation. Patients with vision-threatening uveitis, bilateral inflammation, or uveitis occurring in the setting of systemic involvement may require oral or intravenous administration of corticosteroids. Noncorticosteroid immunosuppressive agents play an important role in limiting the toxic effects of long-term corticosteroid use.

Résumé

Les corticostéroïdes sont lathérapie de première ligne pour les patients qui ont une maladie oculaire inflammatoire non infectieuse. Nous revoyons les facteurs qui contribuent à l’efficacité clinique de diverses préparations de corticostéroïdes chez les patients atteints d’uvéite et discutons des aspects pratiques des indications de traitement, quand administrer les divers agents et comment doser et surveiller le traitement et les effets indésirables. L’application topique des corticosteroïdes est typiquement indiquée pour le traitement de l’uvéite antérieure, alors que les agents périoculaires ou intravitréens sont utilisés le plus souvent pour la gestion de l’inflammation intraoculaire intermédiaire ou postérieure. Les patients qui ont une uvéite menaçant la vision, une inflammation bilatérale ou une uvéite survenant dans le cadre d’une implication systémique peuvent demander l’administration de corticostéroïdes par voie orale ou intraveineuse. Les agents immunosuppressifs non corticostéroïdes jouent un rôle important pour limiter les effets toxiques de l’emploi à long terme de corticostéroïdes.

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    a

    Presented in part at the Canadian Ophthalmological Society Annual Meeting, Quebec, Que., June 26–29, 2010

    b

    This article has been peer-reviewed.

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