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Treatment of Uveitis

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					Treatment Of Uveitis
Robert Goldfien, MD April 23, 2004

Treatment Goals


Symptom Relief
– Pain, photophobia, blurred vision

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Prevent Visual Loss
Prevent Synechiae Formation

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Approach to Treatment



Anterior Uveitis
Topical:
 Steroid drops  Cycloplegics




Posterior Uveitis
Local:
 Periocular steroid injections



Systemic:



Systemic:

 Corticosteroids  Steroid sparing agents

 Corticosteroids  Steroid sparing agents

Treatment of Refractory Uveitis: Conventional Therapies
Drug Dosage and route Monitoring

Methotrexate

10-25 mg/week Monitor as in RA Oral or parenera
5 mg/kg/day, oral
1-1.5 mg/kg/day, oral

Cyclosporine
Azathioprine

Monitor creatinine, Mg++ and lytes
Montor CBC and LFTs

Cyclophosphamide

1-1.5 mg/kg/day, oral

Monitor CBC and Urinalysis

Refractory Uveitis: Newer Treatments
Fluocinolone acetonide intraocular implants
 Implanted

into vitreous  Release drug for up to 3 years  Early experience promising with improvement in visual acuity and reduction in systemic therapy

Refractory Uveitis: Newer Treatments
TNF-alpha inhibitors: Etanercept


Reiff, et al: A & R--10 children, 7 with JRA 63% overall improvement after 3 months



Smith: 12 pts with uveitis, most with rheumatic syndromes--15% improved, but 2 pts first developed uveitis with treatment

Refractory Uveitis: Newer Treatments
TNF-alpha inhibitors: infliximab


Joseph, et al: Treated 5 pts with posterior uveitis, 3 with Behcet’s, 2 idiopathic--4 of 5 improved markedly within 2 weeks. 1 developed pulmonary TB. 5 mg/kg dosing All pts had failed multiple treatments, including cyclophosphamide, tacrolimus, cyclosporine, mycophenolate



Refractory Uveitis: Newer Treatments
TNF-alpha inhibitors: infliximab


El-Shabrawi et al: Treated 12 pts with anterior uveitis and HLA-B27--6 of 7 improved within days. Used 10 mg/kg dosing. Several had flares (median interval 5 months) and responded to same treatment

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Treatment of Uveitis: Summary
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

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 

Treatment goals: symptom relief and preservation of sight Topical treatment first line with anterior uveitis Start with prednisone 1mg/kg oral if systemic treatment required Steroid sparing agents for refractory disease TNF-alpha agents show promising results


				
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