Skip to main content

Corticosteroid in Uveitis

  • Chapter
Uveitis: An Update
  • 1180 Accesses

Abstract

Corticosteroids form the mainstay of therapy for noninfectious uveitis. The anti-inflammatory and immunosuppressive action is mediated by controlling the protein synthesis both at cellular and molecular level. Corticosteroids in uveitis can be administered by topical, periocular, intravitreal, and oral routes. Long-term use of corticosteroids is associated with side effects such as hypertension, osteoporosis, hyperglycemia, Cushing’s syndrome, cataract, glaucoma, and others. Corticosteroid-sparing immunosuppressive agents form the next line of treatment in chronic, recurrent, and nonresponsive uveitis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Fauci AS. Clinical aspects of immunosuppression: use of cytotoxic agents and corticosteroids. Immunology. Philadelphia: WB Saunders; 1978.

    Google Scholar 

  2. Nussenblatt RB, Whitcup SM, Palestine AG. Uveitis: fundamentals and clinical practice. St. Louis: Mosby; 1996.

    Google Scholar 

  3. McGhee CN. Pharmacokinetics of ophthalmic corticosteroids. Br J Ophthalmol. 1992;76:681–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Leopold IH, Maylath R. Intraocular penetration of cortisone and its effectiveness against experimental corneal burns. Am J Ophthalmol. 1952;42:1125–34.

    Article  Google Scholar 

  5. Schoenwald RD, Stewart P. Effect of particle size on ophthalmic bioavailability of dexamethasone suspensions in rabbits. J Pharm Sci. 1980;69:391–4.

    Article  CAS  PubMed  Google Scholar 

  6. Awan MA, Agarwal PK, Watson DG, McGhee CN. Dutton. Penetration of topical and subconjunctival corticosteroids into human aqueous humour and its therapeutic significance. Br J Ophthalmol. 2009;93:708–13.

    Article  CAS  PubMed  Google Scholar 

  7. Foster CS, Davanzo R, Flynn TE, McLeod K, Vogel R, Crockett RS. Durezol (Difluprednate Ophthalmic Emulsion 0.05%) compared with Pred Forte 1% ophthalmic suspension in the treatment of endogenous anterior uveitis. J Ocul Pharmacol Ther. 2010;26:475–83.

    Article  CAS  PubMed  Google Scholar 

  8. Nozik RA. Periocular injection of steroids. Trans Am Acad Ophth Otol. 1976;76:695–704.

    Google Scholar 

  9. Helm CJ, Holland GN. The effects of posterior subtenon injection of triamcinolone acetonide in patients with intermediate uveitis. Am J Ophthalmol. 1995;120:55–64.

    Article  CAS  PubMed  Google Scholar 

  10. Salek SS, Leder HA, Butler NJ, Gan TJ, Dunn JP, Thorne JE. Periocular triamcinolone acetonide injections for control of intraocular inflammation associated with uveitis. Ocul Immunol Inflamm. 2013;21(4):257–63.

    Google Scholar 

  11. Beer PM, Bakri SJ, Singh RJ, et al. Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection. Ophthalmology. 2003;110:681–6.

    Article  PubMed  Google Scholar 

  12. Habot-Wilner Z, Sallam A, Pacheco PA, Do HH, McCluskey P, Lightman S. Intravitreal triamcinolone acetonide as adjunctive treatment with systemic therapy for uveitic macular edema. Eur J Ophthalmol. 2011;21 Suppl 6:S56–61.

    Article  PubMed  Google Scholar 

  13. Williams GA, Haller JA, Kuppermann BD, Blumenkranz MS, Weinberg DV, Chou C, Whitcup SM, Dexamethasone DDS Phase II Study Group. Dexamethasone posterior-segment drug delivery system in the treatment of macular edema resulting from uveitis or Irvine-Gass syndrome. Am J Ophthalmol. 2009;147:1048–54.

    Article  CAS  PubMed  Google Scholar 

  14. Lowder C, Belfort Jr R, Lightman S, Foster CS, Robinson MR, Schiffman RM, Li XY, Cui H, Whitcup SM, Ozurdex HURON Study Group. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011;129:545–53.

    Article  PubMed  Google Scholar 

  15. Jaffe GJ, Martin D, Callanan D, Pearson PA, Levy B, Comstock T, Fluocinolone Acetonide Uveitis Study Group. Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four-week results of a multicenter randomized clinical study. Ophthalmology. 2006;113:1020–7.

    Article  PubMed  Google Scholar 

  16. Arcinue CA, Cerón OM, Foster CS. A comparison between the fluocinolone acetonide (retisert) and dexamethasone (ozurdex) intravitreal implants in uveitis. J Ocul Pharmacol Ther. 2013;29:501–7.

    Article  CAS  PubMed  Google Scholar 

  17. Multicenter Uveitis Steroid Treatment (MUST) Trial Research Group, Kempen JH, Altaweel MM, Holbrook JT, Jabs DA, Louis TA, Sugar EA, Thorne JE. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. 2011;118(10):1916–26.

    Article  Google Scholar 

  18. Thorne JE, Woreta FA, Dunn JP, Jabs DA. Risk of cataract development among children with juvenile idiopathic arthritis-related uveitis treated with topical corticosteroids. Ophthalmology. 2010;117:1436–41.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Slabaugh MA, Herlihy E, Ongchin S, van Gelder RN. Efficacy and potential complications of difluprednate use for pediatric uveitis. Am J Ophthalmol. 2012;153:932–8.

    Article  CAS  PubMed  Google Scholar 

  20. Say EA, Shields CL, Bianciotto C, Shields JA. Perilymphatic subcutaneous fat atrophy and cutaneous depigmentation after periocular triamcinolone acetonide injection in a child. J AAPOS. 2011;15:107–8.

    Article  PubMed  Google Scholar 

  21. Jonas JB, Kamppeter BA. Intravitreal triamcinolone acetonide and central serous chorioretinopathy. Br J Ophthalmol. 2005;89:386–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Malclès A, Janin-Manificat H, Yhuel Y, Russo A, Agard E, El Chehab H, Ract Madoux G, Masse H, Burillon C, Dot C. Anterior chamber migration of intravitreal dexamethasone implant (Ozurdex®) in pseudophakic eyes: report of three cases. J Fr Ophtalmol. 2013;36:362–7.

    Article  PubMed  Google Scholar 

  23. Bansal R, Bansal P, Kulkarni P, Gupta V, Sharma A, Gupta A. Wandering Ozurdex(®) implant. J Ophthalmic Inflamm Infect. 2012;2:1–5.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Ufret-Vincenty RL, Singh RP, Lowder CY, Kaiser PK. Cytomegalovirus retinitis after fluocinolone acetonide (Retisert) implant. Am J Ophthalmol. 2007;143:334–5.

    Article  PubMed  Google Scholar 

  25. Ramaiya KJ, Rao PK. Herpetic necrotizing retinitis following fluocinolone acetonide intravitreal implant. Ocul Immunol Inflamm. 2011;19:72–4.

    Article  PubMed  Google Scholar 

  26. Sims JL, Chee SP. Cytomegalovirus endotheliitis following fluocinolone acetonide (Retisert) implant. Eye. 2010;24:197–8.

    Article  CAS  PubMed  Google Scholar 

  27. Rofagha S, Prechanond T, Stewart JM. Late spontaneous dissociation of a fluocinolone acetonide implant (Retisert). Ocul Immunol Inflamm. 2013;21:62–3.

    Article  Google Scholar 

  28. Jabs DA, Rosenbaum JT, Foster CS, Holland GN, Jaffe GJ, Louie JS, Nussenblatt RB, Stiehm ER, Tessler H, Van Gelder RN, et al. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Am J Ophthalmol. 2000;130:492–513.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mamta Agarwal .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer India

About this chapter

Cite this chapter

Agarwal, M. (2016). Corticosteroid in Uveitis. In: Biswas, J., Majumder, P. (eds) Uveitis: An Update. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2295-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-81-322-2295-8_5

  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-2294-1

  • Online ISBN: 978-81-322-2295-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics