A review of evidence guiding the use of corticosteroids in the treatment of intraocular inflammation

Gaudio, Paul A.

doi:10.1080/092739490500192

Cited by 64 publications

(44 citation statements)

References 79 publications

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“…9,10 At present, the therapy for uveitis, generally based on the use of corticoids, is essentially directed toward pain reduction and avoiding lesions of ocular tissues. 11,12 However, the immunosuppressive effect of corticoids may contribute to the development of the systemic disease, and their chronic use could induce cortisonic glaucoma. 13,14 Non-steroidal anti-inflammatory drugs are also indicated for uveitis treatment, but they may delay the reparation process and coagulation, or produce acute renal insufficiency, gastrointestinal hemorrhage, or ulceration.…”

Section: Uveitis Is a Common Ophthalmic Disorder That Can Be Induced mentioning

confidence: 99%

Therapeutic Effect of Melatonin in Experimental Uveitis

Sande

Fernandez

Marcos

et al. 2008

The American Journal of Pathology

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Uveitis is a common ophthalmic disorder that can be induced in hamsters by a single intravitreal injection of bacterial lipopolysaccharide (LPS). To examine the therapeutic effects of melatonin on uveitis, a pellet of melatonin was implanted subcutaneously 2 hours before the intravitreal injection of either vehicle or LPS. Both 24 hours and 8 days after the injection, inflammatory responses were evaluated in terms of i) the integrity of the blood-ocular barrier, ii) clinical signs, iii) histopathological studies, and iv) retinal function. Melatonin reduced the leakage of proteins and cells in the anterior segment of LPS-injected eyes, decreased clinical signs such as dilation of the iris and conjunctival vessels, and flare in the anterior chamber, and protected the ultrastructure of the blood-ocular barrier. A remarkable disorganization of rod outer segment membranous disks was observed in animals injected with LPS, whereas no morphological changes in photoreceptor outer segments were observed in animals treated with melatonin. Furthermore, melatonin prevented a decrease in LPS-induced electroretinographic activity. In addition, melatonin significantly abrogated the LPS-induced increase in retinal nitric-oxide synthase activity, tumor necrosis factor-␣, and nuclear factor B p50 and p65 subunit levels. These results indicate that melatonin prevents the clinical, biochemical, histological, ultrastructural, and functional consequences of experimental uveitis, likely through a nuclear factor B-dependent mechanism, and support the use of melatonin as a new therapeutic strategy for the treatment of uveitis. (Am J Pathol

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Section: Uveitis Is a Common Ophthalmic Disorder That Can Be Induced mentioning

confidence: 99%

Therapeutic Effect of Melatonin in Experimental Uveitis

Sande

Fernandez

Marcos

et al. 2008

The American Journal of Pathology

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“…Studies investigating the antiinflammatory ocular potencies of topical glucocorticoids have typically been based on models of experimental keratitis, which have given conflicting results at times [7], but techniques such as anterior chamber fluorophotometry can be useful, and suggest that dexamethasone sodium 0.1% and prednisolone acetate 1% are broadly equivalent [8,9]. …”

Section: Topical Corticosteroidsmentioning

confidence: 99%

New Developments in Corticosteroid Therapy for Uveitis

et al. 2010

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Corticosteroids remain the mainstay of the management of patients with uveitis. Topical corticosteroids are effective in the control of anterior uveitis, but vary in strength, ocular penetration and side effect profile. Systemic corticosteroids are widely used for the management of posterior segment inflammation which requires treatment, particularly when it is associated with systemic disease or when bilateral ocular disease is present. However, when ocular inflammation is unilateral, or is active in one eye only, local therapy has considerable advantages, and periocular injections of corticosteroid are a useful alternative to systemic medication and are very effective in controlling mild or moderate intraocular inflammation. More recently, the injection of intraocular corticosteroids such as triamcinolone have been found to be effective in reducing macular oedema and improving vision in uveitic eyes which have proved refractory to systemic or periocular corticosteroids. The effect is usually transient, lasting around 3 months, but can be repeated although the side effects of cataract and raised intraocular pressure are increased in frequency with intraocular versus periocular corticosteroid injections. This has led to the development of new intraocular corticosteroid devices which are designed to deliver sustained-release drugs and obviate the need for systemic immunosuppressive treatment. The first such implant was Retisert, which is surgically implanted (in the operating theatre) and is designed to release fluocinolone over a period of about 30 months. More recently, Ozurdex, a ‘bioerodible’ dexamethasone implant which can be inserted in an office setting, has completed phase III clinical trials in patients with intermediate and posterior uveitis. This implant lasts approximately 6 months, and has been found to be effective with a much better side effect profile than Retisert or intravitreal triamcinolone injection, at least for one injection.

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“…The long acting and constant presence of local steroid appears to be an important action as TA is only a moderate strength steroid, four times the strength of hydrocortisone. 8 In addition, there may be a steroid-mediated local inhibitory action on the new vessels. 9,10 Subconjunctival steroids appear to achieve intraocular penetration mainly through the temporary incision leakage into the tear film and then through the cornea into the eye.…”

Section: Referencementioning

confidence: 99%

“…11,12 We suggest that if SCTA is used for corneal graft rejection, it should be placed as close to the limbus as possible. 8,12 SCTA has been successfully used to reverse neovascularisation in rabbits. This study showed that triamcinolone was present in the cornea for at least 2 weeks after triamcinolone injection.…”

Section: Referencementioning

confidence: 99%