Patient variables help tailor uveitis treatment
Local therapy can work as well as systemic therapy in uveitis management, with shorter-acting steroid agents working better for acute disease and longer-acting agents working better for recurring disease, according to a speaker.
“One size does not fit all in uveitis,” Thomas A. Albini, MD, said at the virtual OSN New York Retina meeting. “You really need to tailor specific treatment plans to specific patients.”
Local therapy is also largely limited by local side effects, Albini said.
In short-acting depot therapies, one should be aware of the “sawtooth phenomenon,” Albini said. “With each injection the patient gets better, but overall they’re losing vision because they’re waiting until they lose vision again to get their next injection.”
There is lack of evidence of efficacy of short-term serial injections, sustained-release therapy is expensive, and one must be “really careful about infections,” Albini said. Furthermore, “surgery always has complications,” and glaucoma and cataracts are known risks of steroid therapy.
The best cases for using local therapy include patients who are intolerant of systemic treatment, patients on complex immunosuppression, and patients with unilateral disease, pseudophakia, history of glaucoma surgery or chronic cystoid macular edema, Albini said.
The best cases to avoid local therapy include children without cataract, patients with existing glaucoma, those who are well controlled on a single-agent immunosuppressive therapy, patients with systemic disease or whose uveitis is suspected to have an infectious etiology, patients who are poorly compliant with therapy and those who are nonresponsive to intravitreal steroids, he said.
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Albini T. The role of sustained steroids in uveitis management. Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).