2. THERAPY FOR UVEITIS

3. OBSERVATION For development of complications
For change in the appearance / severity/progression

4. MEDICAL THERAPY 1 - CYCLOPLEGICS
To relieve pain
To break posterior synechiae/pupillary block
2 – Topical or systemic nonsteroidal anti- inflammatory drugs (NSAIDS)

5. 3 – CORTICOSTEROIDS Topical drops / ointment
Sub – tenon’s or retroseptal injection
Oral or intra venous injection
Intra vitreal injection of triamcinolone
Intravitreal fluocinolone implant (surgically placed)

6. T-Lymphocyte modulators Biologic response modifiers
4 – I MMUNOMODULATORS
Alkylating agents
Antimetabolites
T-Lymphocyte modulators
Biologic response modifiers

7. Mydriatic and cycloplegic Agents
Breaking or preventing the formation of PS and for relieving photophobia secondary to ciliary spasm cyclogyl-tropicamide

8. NSAIDS
Inhibiting cyclooxygenase and reduce the synthesis of prostaglandins that mediate inflammation
Complications of prolonged systemic NSAID: gastric ulceration , GI bleeding , nephrotoxicity , Hepatotoxicity.

9. CORTICOSTEROIDS Treatment of active inflammation in the eye
The mainstay of uveitis therapy
Treatment of active inflammation in the eye
Prevention or treatment of complications such as CME
Reduction of inflammatory infiltration of the retina , choroid , optic nerve

11. TOPICAL For anterior uveitis
For vitritis or macular edema in pseudophakic or aphakic
Rimexolone , Loteprednol and fluorometholone have been shown to have less of an ocular hypertensive effect than other medication

12. Periocular
When a more posterior effect is needed or when a patient is non compliant or poorly responsive to topical or systemic administration Triamcinolone acetonide (40mg) Methylprednisolone acetate (40-80mg)

13. Sub – tenon̕̕s (NOZIK technique) Complications : Superotemporal:
upper lid ptosis
periorbital hemorrhage
globe perforation

15. Transseptal Complications: Periorbital and retrobulbar hemorrhage
Lower lid retractor ptosis
Orbital fat prolapse
Orbital fat atrophy
Skin discoloration

17. Contraindication of periocular injections
Infectious uveitis (eg, toxoplasmosis)
Necrotizing scleritis
High IOP

18. Systemic Oral or intravenous
For vision – threatening chronic uveitis when topical are insufficient
The systemic disease also requires therapy Prednisone is the most commonly used
Duration of treatment may last for 3 months
Longer than 3 months , immunomodulatory therapy is indicated
1-2 mg/kg/day oral prednisone
taperd every 1 to 2 weeks

19. in explosive onset of sever noninfectious posterior uveitis or panuveitis, Iv, high-dose pulse methylprednisolone (1 gm/day infused over 1 hour) therapy for 3 days , followed by a gradual taper of oral prednisolone starting at mg/kg/day
Side effects : Psychological disturbances hypertension and elevated glucose levels .
This form of therapy should be performed in a hospital

20. INTRAVITREAL Triamcinolone acetonide (kenalog)
4mg (0.1cc)of triamcinolone improve VA for 6 months or more
cystoid ME may relapse after 3 to 6 months multiple inj. increase the risk of cat formation & IOP
Endophthalmitis & rhegmatogenous RD
Implantation of a sustained – release device

21. IMMUNOMODULATORY Severe sight-threatening uveitis
Resistant to or intolerant of corticosteroids
killing the rapidly dividing clones of lymphocytes that are responsible for the inflammation

22. INDICATIONS Vision – threatening intraocular inflammation
Reversibility of the disease process
Inadequate response to corticosteroid treatment
Failure of therapy
Contra indication of corticosteroid treatment because of systemic problems or intolerable side effects
Unacceptable corticosteroid side effect
Chronic corticosteroid dependence

23. Adamantiades – Behcet syndrome sympathetic ophthalmia , VKH disease, necrotizing sclerouveitis

24. Treatment Absence of infection
Absence of hepatic and hematologic contraindications
Meticulous follow – up by a physician
Objective longitudinal evaluation of the disease process
Informed consent