Different routes of steroidal administration for non-infectious uveitis: perspective
DOI:
https://doi.org/10.12809/hkjo-v27n2-356Keywords:
Intravitreal injections, Steroids, Uveitis, intermediate, Uveitis, posteriorAbstract
Uveitis is inflammation of the iris, ciliary body, and/or choroid and accounts for 10% to 15% of legal blindness cases in Europe and the United States, and particularly affects working-age people. Systemic steroids are the first-line treatment for intermediate and posterior non-infectious uveitis (NIU), whereas topical steroids are reserved for anterior uveitis. However, systemic steroids can lead to complications such as hypertension, diabetes, and secondary infection. Local use of steroids can suppress intraocular inflammation and cystic macular edema with fewer systemic risks. Intravitreal dexamethasone, fluocinolone acetonide, and/or triamcinolone acetonide implants can improve visual acuity and reduce central retinal thickness. Additionally, suprachoroidal injections of triamcinolone acetonide can reduce central subfield thickness in patients with uveitis. Subtenon injections of triamcinolone acetonide reduce central macular thickness more than periocular injections. Systemic intravenous methylprednisolone pulses can rapidly suppress uveal tract inflammation. Topical use of dexamethasone-cyclodextrin nanoparticles can penetrate the anterior segment to resolve vitritis and macular edema, but cataract progression, elevated intraocular pressure, and deterioration of glaucoma may still occur. During the COVID-19 pandemic, uveitis specialists preferred to use local corticosteroids rather than systemic immunosuppressants and biologics. They advocated dose tapering in patients taking high-dose corticosteroids to reduce their susceptibility to viral infection. NIU is increasingly managed with local steroids to reduce infection risk. This article highlights different routes for steroidal treatments of NIU, including intravitreal, suprachoroidal, periocular, systemic, and topical routes. It also discusses how NIU was managed during the COVID-19 pandemic, specifically addressing the use of immunosuppressants and biologics.
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