Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Intermediate Uveitis Medication

  • Author: Robert H Janigian, Jr, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Oct 05, 2015
 

Medication Summary

The goal is to suppress intraocular inflammation, which usually is accomplished with systemic corticosteroids. In some cases, this treatment is inadequate, and immunosuppressive or immune-modulating agents are required to control the disease. These agents can be used adjunctively with steroids or alone.

Next

Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

Prednisone (Deltasone, Meticorten, Orasone)

 

Readily absorbed through the GI tract and inhibits phospholipase A2 (an enzyme that liberates arachidonic acid from phospholipids in the production of inflammatory mediators).

Triamcinolone (Amcort)

 

A long-acting depo-steroid. For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Observe for ptosis or anterior dissection. Generic preparations appear to be equally efficacious compared to proprietary Kenalog.

Prednisolone 1% (Pred Forte)

 

Has 3-5 times the anti-inflammatory action as hydrocortisone. Glucocorticoids inhibit the edema, fibrin deposition, capillary dilation and phagocytic migration of the acute inflammatory response. Steroids are also potent inhibitors of the inflammatory enzyme cascade, angiogenesis, and mast-cell degranulation. Steroids stabilize cell membranes.

Loteprednol etabonate binds to anti-inflammatory receptors 4.3 times more avidly than dexamethasone. Possible reduced risk of glaucoma due to ester substitution for ketone moiety at the 20 position on the steroid cholesterol ring. Shake well for susp (acetate).

Previous
Next

Immunosuppressives

Class Summary

Inhibit cell-mediated and (to a lesser degree) humoral immunity by arresting T-lymphocyte activity. The ultimate goal is to suppress inflammation.

Cyclosporine (Sandimmune, Neoral)

 

A cyclic polypeptide produced as a fungus metabolite, capable of reversibly arresting the T-lymphocyte cell cycle in the G0 and G1 phases. Potent down-regulator of interleukin 2 production and receptor expression. Newer Neoral preparation is better absorbed and may require marked dosage reductions.

Azathioprine (Imuran)

 

Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. May decrease proliferation of immune cells, which results in lower autoimmune activity.

Methotrexate (Folex PFS, Rheumatrex)

 

Antimetabolite that inhibits dihydrofolate reductase, thereby inhibiting DNA synthesis in rapidly replicating cells. Immunosuppressive actions may be related to reduction in cytokines. Available as 2.5-mg pills.

Previous
Next

Histamine H2-receptor antagonist

Class Summary

Reduces postprandial daytime and nighttime gastric acid secretion by about 50-80%. May increase gastromucosal defense and healing in acid-related disorders (ie, stress-induced ulcers) by increasing production of gastric mucus, increasing mucosal secretion of bicarbonate and gastric mucosal blood flow as well as increasing endogenous mucosal synthesis of prostaglandins. Histamine H2-receptor antagonists can be used prophylactically to prevent gastritis and ulcer disease in patients taking oral or intravenous corticosteroids.

Cimetidine (Tagamet)

 

Used as prophylaxis against corticosteroid induced gastric and duodenal ulcer.

Consult with internist if patient has preexisting symptoms of GERD or peptic ulcer disease prior to beginning corticosteroid therapy.

Ranitidine (Zantac)

 

Used as prophylaxis against corticosteroid-induced gastric and duodenal ulcer.

Previous
Next

Gastric pump inhibitors

Class Summary

Thought to be a gastric pump inhibitor in that it blocks the final step of acid production by inhibiting the H+/K+ -ATPase system at the secretory surface of the gastric parietal cell. Both basal and stimulated acid secretions are inhibited. Short-term (4-8 wk) treatment of active duodenal ulcer, active benign gastric ulcer, erosive esophagitis (all grades), and heartburn and other symptoms associated with GERD.

Omeprazole (Prilosec)

 

Decreases gastric acid secretion by inhibiting the parietal cell H+/K+ -ATP pump.

Lansoprazole (Prevacid)

 

Inhibits gastric acid secretion.

Esomeprazole magnesium (Nexium)

 

S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H+/K+ -ATPase enzyme system at secretory surface of gastric parietal cells.

Previous
 
 
Contributor Information and Disclosures
Author

Robert H Janigian, Jr, MD Clinical Assistant Professor, Department of Surgery (Ophthalmology), Brown University Medical School

Robert H Janigian, Jr, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Rhode Island Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Brian A Welcome, MD Staff Physician, Department of Ophthalmology, Rhode Island Hospital

Brian A Welcome, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Glaucoma Society, American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Theodoros Filippopoulos, MD Head of Glaucoma Clinic, Athens Vision Eye Institute; Clinical Lecturer, Department of Ophthalmology, Second Ophthalmology Clinic, University of Athens Medical School, Greece

Theodoros Filippopoulos, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Retina Society, American College of Healthcare Executives, American Uveitis Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

References
  1. Kimura SJ, Hogan MJ. Chronic Cyclitis. Arch of Ophthalmol. 1964. 71:193-201.

  2. Raja SC, Jabs DA, Dunn JP, et al. Pars Planitis: Clinical Features and Class II HLA Associations. Ophthalmology. 1999. 106 (3):594-599. [Medline].

  3. Malinowski SM, Pulido JS, Folk JC. Long-term visual outcome and complications associated with pars planitis. Ophthalmology. 1993 Jun. 100(6):818-24; discussion 825. [Medline].

  4. Henderly DE, Haymond RS, Rao NA, et al. The significance of the pars plana exudate in pars planitis. Am J Ophthalmol. 1987 May 15. 103(5):669-71. [Medline].

  5. Rodriguez A, Calonge M, Pedroza-Seres M, et al. Referral Patterns of Uveitis in a Tertiary Care Center. Archives of Ophthalmology. 1996. 114 (5):593-599. [Medline].

  6. Kaplan HJ. Intermediate Uveitis (Pars Planitis, Chronic Cyclitis)- A Four Step Approach to Treatment. Saari KM, ed. Uveitis Update. Amsterdam: Exerpta Medica; 1984. 169-172.

  7. Hogewind BF, Zijlstra C, Klevering BJ, et al. Intravitreal triamcinolone for the treatment of refractory macular edema in idiopathic intermediate or posterior uveitis. Eur J Ophthalmol. 2008 May-Jun. 18(3):429-34. [Medline].

  8. Murphy CC, Greiner K, Plskova J, et al. Cyclosporine vs tacrolimus therapy for posterior and intermediate uveitis. Arch Ophthalmol. 2005 May. 123(5):634-41. [Medline].

  9. Markomichelakis NN, Theodossiadis PG, Pantelia E, et al. Infliximab for chronic cystoid macular edema associated with uveitis. Am J Ophthalmol. 2004 Oct. 138(4):648-50. [Medline].

  10. Rajaraman RT, Kimura Y, Li S, et al. Retrospective case review of pediatric patients with uveitis treated with infliximab. Ophthalmology. 2006 Feb. 113(2):308-14. [Medline].

  11. Devenyi RG, Mieler WF, Lambrou FH, et al. Cryopexy of the vitreous base in the management of peripheral uveitis. Am J Ophthalmol. 1988 Aug 15. 106(2):135-8. [Medline].

  12. Park SE, Mieler WF, Pulido JS. 2 peripheral scatter photocoagulation for neovascularization associated with pars planitis. Arch Ophthalmol. 1995 Oct. 113(10):1277-80. [Medline].

  13. Becker M, Davis J. Vitrectomy in the treatment of uveitis. Am J Ophthalmol. 2005 Dec. 140(6):1096-105. [Medline].

  14. Quinones K, Choi JY, Yilmaz T, Kafkala C, Letko E, Foster CS. Pars plana vitrectomy versus immunomodulatory therapy for intermediate uveitis: a prospective, randomized pilot study. Ocul Immunol Inflamm. 2010 Oct. 18(5):411-7. [Medline].

  15. Jaffe GJ, Martin D, Callanan D, et al. Fluocinolone acetonide implant (Retisert) for noninfectious posterior uveitis: thirty-four-week results of a multicenter randomized clinical study. Ophthalmology. 2006 Jun. 113(6):1020-7. [Medline].

  16. Lowder C, Belfort R Jr, Lightman S, Foster CS, Robinson MR, Schiffman RM, et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011 May. 129(5):545-53. [Medline].

  17. Thorne JE, Daniel E, Jabs DA, et al. Smoking as a risk factor for cystoid macular edema complicating intermediate uveitis. Am J Ophthalmol. 2008 May. 145(5):841-6. [Medline].

  18. Kalinina Ayuso V, Ten Cate HA, van den Does P, Rothova A, de Boer JH. Young age as a risk factor for complicated course and visual outcome in intermediate uveitis in children. Br J Ophthalmol. 2011 May. 95(5):646-51. [Medline].

  19. Abu El-Asrar AM, Geboes K. An immunohistochemical study of the 'snowbank' in a case of pars planiti. Ocul Immunol Inflamm. 2002 Jun. 10(2):117-23. [Medline].

  20. Androudi S, Ahmed M, Fiore T, et al. Combined pars plana vitrectomy and phacoemulsification to restore visual acuity in patients with chronic uveitis. J Cataract Refract Surg. 2005 Mar. 31(3):472-8. [Medline].

  21. Becker MD, Heiligenhaus A, Hudde T, et al. Interferon as a treatment for uveitis associated with multiple sclerosis. Br J Ophthalmol. 2005 Oct. 89(10):1254-7. [Medline].

  22. Biswas J, Raghavendran SR, Vijaya R. Intermediate uveitis of pars planitis type in identical twins. Report of a case. Int Ophthalmol. 1998. 22(5):275-7. [Medline].

  23. Bloch-Michel E, Nussenblatt RB. International Uveitis Study Group recommendations for the evaluation of intraocular inflammatory disease. Am J Ophthalmol. 1987 Feb 15. 103(2):234-5. [Medline].

  24. Bonfioli AA, Damico FM, Curi AL, et al. Intermediate uveitis. Semin Ophthalmol. 2005 Jul-Sep. 20(3):147-54. [Medline].

  25. Bora NS, Bora PS, Tandhasetti MT, et al. Molecular cloning, sequencing, and expression of the 36 kDa protein present in pars planitis. Sequence homology with yeast nucleopore complex protein. Invest Ophthalmol Vis Sci. 1996 Aug. 37(9):1877-83. [Medline].

  26. Boyd SR, Young S, Lightman S. Immunopathology of the noninfectious posterior and intermediate uveitides. Surv Ophthalmol. 2001 Nov-Dec. 46(3):209-33. [Medline].

  27. Brockhurst RJ, Schepens CL, Okamura ID. Uveitis II. Peripheral Uveitis: Clinical Descriptions, Complications and Differential Diagnosis. Am J Ophthalmol. 1960. 49:1257-1266.

  28. Capone A Jr, Aaberg TM. Intermediate Uveitis. In: Albert, Jacobiec FA, eds. Principles and Practice of Ophthalmology. 1994. Philadelphia: WB Saunders:423-442.

  29. Doro D, Manfre A, Deligianni V, et al. Combined 50- and 20-MHz frequency ultrasound imaging in intermediate uveitis. Am J Ophthalmol. 2006 May. 141(5):953-5. [Medline].

  30. Duguid IG, Ford RL, Horgan SE, et al. Combined orbital floor betamethasone and depot methylprednisolone in uveitis. Ocul Immunol Inflamm. 2005 Feb. 13(1):19-24. [Medline].

  31. Ganesh SK, Babu K, Biswas J. Phacoemulsification with intraocular lens implantation in cases of pars planitis. J Cataract Refract Surg. 2004 Oct. 30(10):2072-6. [Medline].

  32. Guest S, Funkhouser E, Lightman S. Pars planitis: a comparison of childhood onset and adult onset disease. Clin Experiment Ophthalmol. 2001 Apr. 29(2):81-4. [Medline].

  33. Holland GN. The enigma of pars planitis, revisited. Am J Ophthalmol. 2006 Apr. 141(4):729-30. [Medline].

  34. Jabs DA, Nussenblatt RB, Rosenbaum JT, et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep. 140(3):509-16. [Medline].

  35. Jain R, Ferrante P, Reddy GT, et al. Clinical features and visual outcome of intermediate uveitis in children. Clin Experiment Ophthalmol. 2005 Feb. 33(1):22-5. [Medline].

  36. Kaplan HJ. Surgical Treatment of Intermediate Uveitis. Developments in Ophthalmology. 1992. 23:185-189. [Medline].

  37. Malik AR, Pavesio C. The use of low dose methotrexate in children with chronic anterior and intermediate uveitis. Br J Ophthalmol. 2005 Jul. 89(7):806-8. [Medline].

  38. Miserocchi E, Baltatzis S, Ekong A, et al. Efficacy and safety of chlorambucil in intractable noninfectious uveitis: the Massachusetts Eye and Ear Infirmary experience. Ophthalmology. 2002 Jan. 109(1):137-42. [Medline].

  39. Murphy CC, Hughes EH, Frost NA, et al. Quality of life and visual function in patients with intermediate uveitis. Br J Ophthalmol. 2005 Sep. 89(9):1161-5. [Medline].

  40. Nussenblatt RB, Peterson JS, Foster CS, et al. Initial evaluation of subcutaneous daclizumab treatments for noninfectious uveitis: a multicenter noncomparative interventional case series. Ophthalmology. 2005 May. 112(5):764-70. [Medline].

  41. Nussenblatt RB, Whitcup SM, Palestine AG. Uveitis: Fundamentals and Clinical Practice. 3rd ed. St. Louis: CV Mosby; 2004. 291-300.

  42. Okada AA. Noninfectious uveitis: a scarcity of randomized clinical trials. Arch Ophthalmol. 2005 May. 123(5):682-3. [Medline].

  43. Potter MJ, Myckatyn SO, Maberley AL, et al. Vitrectomy for pars planitis complicated by vitreous hemorrhage: visual outcome and long-term follow-up. Am J Ophthalmol. 2001 Apr. 131(4):514-5. [Medline].

  44. Reinthal EK, Volker M, Freudenthaler N, et al. [Optical coherence tomography in the diagnosis and follow-up of patients with uveitic macular edema]. Ophthalmologe. 2004 Dec. 101(12):1181-8. [Medline].

  45. Smith RE. Pars Planitis. Ryan SJ, ed. Retina. St. Louis: CV Mosby; 1973. Vol. 2: 637-646.

  46. Smith RE, Godfrey WA, Kimura SJ. Chronic cyclitis. I. Course and visual prognosis. Trans Am Acad Ophthalmol Otolaryngol. 1973 Nov-Dec. 77(6):OP760-8. [Medline].

  47. Smith RE, Nozik RA. Uveitis: A Clinical Approach to Diagnosis and Management. 2nd ed. Baltimore: Williams and Wilkins; 1989. 166-170.

  48. Stanford MR, Vaughan RW, Kondeatis E, et al. Are cytokine gene polymorphisms associated with outcome in patients with idiopathic intermediate uveitis in the United Kingdom?. Br J Ophthalmol. 2005 Aug. 89(8):1013-6. [Medline].

  49. Stavrou P, Baltatzis S, Letko E, et al. Pars plana vitrectomy in patients with intermediate uveitis. Ocul Immunol Inflamm. 2001 Sep. 9(3):141-51. [Medline].

  50. Tabbara KF, Al-Kaff AS, Al-Rajhi AA, et al. Heparin Surface-Modified Intraocular Lenses in Patients with Inactive Uveitis or Diabetes. Ophthalmology. 1998. 105(5):843-845. [Medline].

  51. Tessler HH, Fraber MD. Intraocular Lens Implantation Versus no Intraocular Lens Implantation in Patients with Chronic Iridocyclitis and Pars Planitis: A Randomized Prospective Study. Ophthalmology. 1993. 100 (8):1206-1209. [Medline].

  52. Trittibach P, Koerner F, Sarra GM, et al. Vitrectomy for juvenile uveitis: prognostic factors for the long-term functional outcome. Eye. 2006 Feb. 20(2):184-90. [Medline].

  53. Tugal-Tutkun I, Havrlikova K, Power WJ, et al. Changing patterns in uveitis of childhood. Ophthalmology. 1996 Mar. 103(3):375-83. [Medline].

  54. Ozzello DJ, Palestine AG. Factors affecting therapeutic decisions in intermediate and posterior uveitis. Am J Ophthalmol. 2015 Feb. 159 (2):213-20.e3. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.