A practical approach to the use of corticosteroids in patients with uveitis (Dr Emmett Cunningham)

26Jun2010 0900hrs presented at the COS Annual Meeting in Quebec City by Dr Emmett Cunningham

Opening remark that most uveitis management is classified as off label use (as the original studies when these drops went to mark did not involve case-controlled series’ comparing treatment of patients with uveitis to a control group.) He also mentioned that all the material in this talk will be appearing in an upcoming issue of the Canadian Journal of Ophthalmology.

The talk centred on steroids and why we need to know more about this. He discussed the penetration of different topical steroid formulations and how this only part of story because of potency of the active ingredient is also an important consideration. Prednisolone acetate (PredForte) is the best when consider both penetration and potency. Treatment should start aggressively and then taper slowly. Generic formulations can be just fine though some reports particles not milled properly so if not responding try the brand name product.

Remember that as this is a suspension, to shake 30-40x before each instillation.

Keys to success are the correct medication, its proper use, and compliance. The most common problem is steroids being used too little for too long.

Macular edema, still start with PredForte, though recognize may need peri or intra ocular injection or systemic meds. This way can also see if steroid responder before subjected to steroid injection. (Steroid responder means the intraocular pressure rises significantly when taking steroids. This usually takes up to 4-6 weeks of use to happen but in certain patients this can happen within a few days. Once a steroid is injected in or around the eye, the pressure raising side effects can be quite serious and permanent.)

Superior posterior subtenons injection still the speaker’s preferred delivery method for steroids in or around the eye. However, rather than the originally described subtenon’s delivery superiorly, injection near the orbital floor likely as effective and should not cause ptosis. There is still a need to first inject lidocaine and he does caution that these steroid injections can cause fat atrophy around the eye that can be significant.

Syphilis and CMV been seen after intraocular injection steroids

Durezol is a very potent new topical steroid that is being used in the states now.

Emmett_cunningham@yahoo.com to reach the speaker.

During the discussion period, when asked, Dr Cunningham suggested that he is not convinced of a role for topical NSAIDS in the types of cases he discussed