Immunomodulatory therapy plays role in uveitis treatment
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The goal of therapy for noninfectious uveitis is to control inflammation while minimizing sequelae and side effects, according to one presenter at OSN New York Retina.
“We really don’t want to use long-term systemic corticosteroids, and we avoid as much as we can topical and local corticosteroids in young people,” Debra A. Goldstein, MD, FRCSC, said.
Corticosteroids are the most effective agent for initial control, Goldstein said, but if disease recurs during the tapering-off period, a transition to immunomodulatory therapy or long-acting local therapy should be instituted.
Furthermore, most patients on long-term corticosteroids experience at least a few of the known side effects, Goldstein said.
“The agent that we choose and the route that we use depends on the disease location, disease severity, patient factors and how long we think we will need therapy,” Goldstein said.
Immunomodulatory therapy failure may be due to inadequate dose or the duration of the therapy, Goldstein said. Early, aggressive immunomodulatory therapy should be considered in diseases with potential to cause blindness, including Behçet’s disease with posterior segment involvement, sympathetic ophthalmia, necrotizing scleritis and serpiginous choroidopathy.
Eye diseases often require higher or more frequent doses than systemic diseases do, so communication with the patient’s rheumatologist is important.
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Goldstein DA. A review of systemic immunosuppression for the retina specialist (in 7 minutes!). Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).
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