Corticosteroids remain primary treatment option for uveitis, despite other options

DANA POINT, Calif. – Despite the availability of a number of alternatives, corticosteroids are still considered the primary treatment option for uveitis, according to Scott M. Whitcup, MD.

Dr. Whitcup presented a uveitis update during the Ocular Drug and Surgical Treatment Update meeting here.

He said that, when a patient is diagnosed with uveitis, it is crucial to rule out the presence of any infection or malignancy before beginning anti-inflammatory therapy.

“When a patient presents with inflammation in the anterior segment, topical corticosteroids are generally the best way to control uveitis,” Dr. Whitcup said. He added that the dose should be large at first and then slowly tapered back.

While topical corticosteroids are preferred for most cases of anterior uveitis, they are usually inadequate for treating intermediate and posterior uveitis, he said. In those cases, periocular injections can be effective, particularly for patients with unilateral uveitis. Systemic corticosteroids can also be administered in these cases, he said.

It is necessary to monitor weight, blood pressure and glucose levels every 3 months in patients who are undergoing chronic corticosteroid treatment, Dr. Whitcup said. Lipids should be measured once a year, and bone density should be measured within the first 3 months of treatment and once a year following the beginning of treatment.

Osteoporosis is a concern for patients who are being treated with corticosteroids for uveitis, according to Dr. Whitcup. Studies show that patients prescribed more than a 7.5 mg daily dose of prednisone lost up to 15% of trabecular bone in the lumbar spine within 1 year. Bone loss increased to 30% to 50% at doses of more than 30 mg per day.

Doctors may recommend 1,500 mg of daily calcium, 800 IU of vitamin D, hormone replacement and weight-bearing exercise for patients prone to osteoporosis, he said. Patients who smoke should be strongly encouraged to stop.