Intravitreal anti-inflammatory treatment for uveitis

Corticosteroids and second-line immunosuppressive agents such as cyclosporin and tacrolimus (FK506) can effectively control intraocular inflammation in patients with uveitis1(see page 237). Intraocular inflammation in uveitis causes retinal exudates, retinal haemorrhages, vitreous opacity, serous detachment, retinal neovascularisation and cystoid macular edema. Cystoid macular oedema is the most relevant cause of visual loss associated with uveitis. Oral corticosteroids are useful, but high dosage and prolonged use can cause many serious systemic side effects.2 Second-line immunosuppressive agents are also useful—for example, clinical studies of systemic administration of cyclosporin or tacrolimus have been shown to be effective in treating patients with refractory uveitis, including Behçet’s disease. However, high dosages and prolonged use often cause serious systemic side effects.3,4 Using periocular corticosteroids5,6 and injection of second-line immunosuppressive agents7 confines the anti-inflammatory effect to the eye and minimises the systemic side effects of these oral drugs. However, one has to be very careful with the use of periocular corticosteroids in patients who are responsive to steroids. Recently, successful use of intravitreal triamcinolone acetate has been reported in a case series involving patients with uveitic eyes …