Uveitis pp 58-77 | Cite as

Medical Therapy for Uveitis

  • E. Mitchel Opremcak

Abstract

Optimal therapy for uveitis is predicated on an understanding of the predominant pathophysiologic mechanism(s) responsible for the specific disorder. To that end, antiviral, antibacterial, antiprotozoal, and antihelminthic agents, as well as specific anti-inflammatory and immunosuppressive medications, can be delivered via topical, regional, and systemic routes in specific circumstances. Whatever the form of therapy, the general goals are similar: to improve comfort, to reduce the severity and frequency of the inflammation, to prevent complications of the uveitis, to avoid treatment complications and drug side effects, and ultimately to preserve sight.

Keywords

Prostaglandin Cyclophosphamide Prednisone Ibuprofen Cimetidine 

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References

  1. 1.
    Aronson SB. Potential pathways for anti-inflammatory therapy. Trans Am Acad Ophthalmol Otolaryngol. 1975; 79: 62Google Scholar
  2. 2.
    Opremcak EM. Topical therapy for iritis. Focal Points. 1991; 9: 1.Google Scholar
  3. 3.
    Tsai I, Till GO, Marak GE Jr. Effects of mydriatic agents on neutrophil migration, Ophthalmic Res, in press.Google Scholar
  4. 4.
    Clamen HN. Anti-inflammatory effects of corticosteroids. Clin Immunol Allergy. 1984; 4: 317.Google Scholar
  5. 5.
    Leibowitz HM, Kupferman A. Bioavailability and therapeutic effectiveness of topically administered corticosteroids. Trans Am Acad Ophthalmol Otolaryngol. 1975; 79: 78.Google Scholar
  6. 6.
    Urban RC Jr, Cotlier E. Corticosteroid-induced cataracts. Surv Ophthalmol. 1986; 31: 102.PubMedCrossRefGoogle Scholar
  7. 7.
    Black RL, Oglesby RB, von Sallmann L, et al. Posterior subcapsular cataracts induced by corticosteroids in patients with rheumatoid arthritis. JAMA. 1960; 174: 166.PubMedGoogle Scholar
  8. 8.
    Hodapp EA, Kass MA. Corticosteroid- induced glaucoma. In: Ritch R, Shields MB, eds. The Secondary Glaucomas. St. Louis: CV Mosby; 1982.Google Scholar
  9. 9.
    Armaly MF. Statistical attributes of steroid hypertensive response in the clinically normal eye. Invest Ophthalmol. 1965; 4: 187.PubMedGoogle Scholar
  10. 10.
    Becker B. Intraocular pressure response to topical corticosteroids. Invest Ophthalmol. 1965; 4: 198.PubMedGoogle Scholar
  11. 11.
    Mindel J, Goldberg J, Tavitian H. Similarity of the intraocular pressure response to different corticosteroid esters when compliance is controlled. Ophthalmology. 1979; 86: 98.Google Scholar
  12. 12.
    Cantrill HL, Palmberg PF, Zink HA, et al. Comparison of in vitro potency of corticosteroids with ability to raise intraocular pressure. Am J Ophthalmol. 1975; 79: 1012.PubMedGoogle Scholar
  13. 13.
    Opremcak EM. Nonsteroidal anti-inflammatory drugs. In: Haverner WH, ed. Havener’s Ocular Pharmacology. St. Louis: Mosby-Year Book; 1994.Google Scholar
  14. 14.
    Keates RH, McGowan KA. Clinical trial of flurbiprofen to maintain pupillary dilation during cataract surgery. Ann Ophthalmol. 1984; 16: 919.PubMedGoogle Scholar
  15. 15.
    Flurbiprofen—an ophthalmic NSAID. Med Lett Ther. 1987; 29: 58.Google Scholar
  16. 16.
    Araie M, Sawa M, Takase M. Topical flurbi-profen and diclofenac suppress blood-aqueous barrier breakdown in cataract surgery: a fluorometric study. Jpn J Ophthalmol. 1983; 27: 535.PubMedGoogle Scholar
  17. 17.
    Araie M, Sawa M, Takase M. Effect of topical indomethacin on the blood-aqueous barrier after intracapsular extraction of a senile cataract—a fluorophotometric study. Jpn J Ophthalmol. 1981; 25: 237.Google Scholar
  18. 18.
    Eguchi K, Ohara K, Tobari I, et al. Effects of topical indomethacin on suppression of in-flammation after ocular surgeries—double mask study of anti-inflammatory effects on the intracapsular lens extraction. Acta Soc Ophthalmol Jpn. 1982; 86: 2198.Google Scholar
  19. 19.
    Mochizuki M, Sawa M, Masuda K. Topical indomethacin in intracapsular extraction of a senile cataract. Jpn J Ophthalmol 1977; 21: 215.Google Scholar
  20. 20.
    Sanders DR, Kraff MC, Leiberman HL, et al. Breakdown and re-establishment of blood- aqueous barrier with implant surgery. Arch Ophthalmol 1982; 100: 588.PubMedGoogle Scholar
  21. 21.
    Flach AJ, Kraff MC, Sanders DR, Tanenbaum L. The quantitative effect of 0.5% ketorolac tromethamine solution and 0.1% dexametha- sone sodium phosphate solution on postsurgical blood-aqueous barrier. Arch Ophthalmol 1988; 106: 480.PubMedGoogle Scholar
  22. 22.
    Flach AJ, Jaffe NS, Akers WA. The effect of ketorolac tromethamine in reducing postoperative inflammation: double mask parallel comparison with dexamethasone. Ann Ophthalmol 1989; 21: 407.PubMedGoogle Scholar
  23. 23.
    Sabiiston D, Tessler H, Sumers K, et al. Reduction of inflammation following cataract surgery by the nonsteroidal anti-inflammatory drug flurbiprofen. Ophthalmic Surg. 1987; 18: 873.Google Scholar
  24. 24.
    Flach AJ, Lavelle CJ, Olander KW, et al. The effect of ketorolac tomethamine solution 0.5% in reducing postoperative inflammation after cataract extraction and intraocular lens implantation. Ophthalmology. 1988; 95: 1279.PubMedGoogle Scholar
  25. 25.
    Hurvitz LM, Spaeth GL, Zakhour I, et al. A comparison of the effect of flurbiprofen dexamethasone and placebo on cyclocryotherapy-induced inflammation. Ophthal Surg. 1984; 15: 394.Google Scholar
  26. 26.
    Stark WJ, Worthen DM, Halladay JT. The FDA report on intraocular lenses. Ophthalmology. 1983; 90: 311.PubMedGoogle Scholar
  27. 27.
    Irvine AR. Cystoid macular edema. Surv Ophthalmol 1976; 21: 1.PubMedCrossRefGoogle Scholar
  28. 28.
    The Miami Study Group. Cystoid macular edema in aphakic and pseudophakic eyes. Am J Ophthalmol 1979; 88: 45.Google Scholar
  29. 29.
    Jampol LM. Pharmacologic therapy of aphakic and pseudophakic cystoid maculae edema. Ophthalmology. 1985; 92: 807.PubMedGoogle Scholar
  30. 30.
    Yannuzzi LA. A perspective on the treat-ment of aphakic cystoid macular edema. Surv Ophthalmol 1984; 28: 540.PubMedCrossRefGoogle Scholar
  31. 31.
    Miyake K, Sakamura S, Miura H. Long-term follow-up study on prevention of aphakic cystoid macular edema by topical indomethacin. Br J Ophthalmol 1980; 64: 324.PubMedCrossRefGoogle Scholar
  32. 32.
    Yannuzzi LA, Landau AN, Turtz Al. Incidence of aphakic cystoid macular edema with the use of topical indomethacin. Ophthalmology. 1981; 88: 947.PubMedGoogle Scholar
  33. 33.
    Kraff MC, Sanders DR, Jampol LM, et al. Prophylaxis of psuedophakic cystoid macular edema with topical indomethacin. Ophthalmology. 1982; 89: 885.PubMedGoogle Scholar
  34. 34.
    Miyake K. Indomethacin in the treatment of postoperative cystoid macular edema. Surv Ophthalmol 1984; 28: 554.PubMedCrossRefGoogle Scholar
  35. 35.
    Burnett J, Tessler H, Isenberg S, Tso MOM. Double-masked trial of fenoprofen sodium: treatment of chronic aphakic cystoid macu-lar edema. Ophthal Surg. 1983; 14: 150.Google Scholar
  36. 36.
    Flach AJ, Jampol LM, Weinberg D, et al. Improvement in visual acuity in chronic aphakic and psuedophakic cystoid macular edema after treatment with topical 0.5% ketorolac tromethamine. Am J Ophthalmol 1991; 112: 514.PubMedGoogle Scholar
  37. 37.
    BenEzra D, Maftzir G, de Courten C, Timonen P. Ocular penetration of cyclosporin A. III. The human eye. Br J Ophthalmol 1990; 74: 350.PubMedCrossRefGoogle Scholar
  38. 38.
    Schlaegel TF Jr. Essentials of Uveitis. Boston: Little Brown; 1969: 41.Google Scholar
  39. 39.
    Smith RE, Nozik RA. The nonspecific treatment of uveitis. In: Carol-lynn Brown, ed. Uveitis. A Clinical Approach to Diagnosis and Management. 2nd ed. Baltimore: Williams & Wilkins; 1989: 51.Google Scholar
  40. 40.
    Watson PG. The diagnosis and management of scleritis. Ophthalmology. 1980; 87: 716.PubMedGoogle Scholar
  41. 41.
    Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal anti-inflammatory drugs. N Engl J Med. 1984; 310: 563.PubMedCrossRefGoogle Scholar
  42. 42.
    Langman MJS. Ulcer complications and nonsteroidal anti-inflammatory drugs. Am J Med. 1988; 84 (suppl 2A): 15.PubMedCrossRefGoogle Scholar
  43. 43.
    Brooks PM, Day RO. Nonsteroidal anti-inflammatory drugs—differences and sim-ilarities. N Engl J Med. 1991; 324: 1716.PubMedCrossRefGoogle Scholar
  44. 44.
    Hamberg M, Svenson J, Samuelsson B. Thromboxanes: new group of biologically active compounds derived from prostaglandin endoperoxides. Proc Natl Acad Sci 1975; 72: 2994.Google Scholar
  45. 45.
    Samuelsson B, Borgeat P, Hammarstrom S, et al. Leukotrienes: a new group of biologically active compounds. In: Samuelsson B, Ramwell PW, Paoletti R, eds. Leukotrienes and Other Lipoxygenase Products. New York: Raven Press; 1980: 1.Google Scholar
  46. 46.
    Kass MA, Holmberg NJ. Prostaglandin and thromboxane synthesis by microsomes of rabbit ocular tissues. Invest Ophthalmol Vis Sei. 1979; 18: 166.Google Scholar
  47. 47.
    Bhattacherjee P, Eakins KE. A comparison of the inhibitory activity of compounds on ocular prostaglandin biosynthesis. Invest Ophthalmol Vis Sei. 1974; 13: 967.Google Scholar
  48. 48.
    van Haeringen NJ, Oosterhuis JA, van Delft JL, et al. A comparison of the effects on nonsteroidal compounds on the disruption of the blood-aqueous barrier. Exp Eye Res. 1982; 35: 271.PubMedCrossRefGoogle Scholar
  49. 49.
    Van den Ouweland FA, Gribnau FWJ, van Ginneken CAM, et al. Naproxen kinetics and disease activity in rheumatoid arthritis: a within patient study. Clin Pharmacol Ther. 1988; 43: 79.PubMedCrossRefGoogle Scholar
  50. 50.
    Goodwin JS, Regan M. Cognitive dysfunction associated with naproxen and ibuprofen in the elderly. Arthritis Rheum. 1982; 25: 1013.PubMedCrossRefGoogle Scholar
  51. 51.
    Netter P, Lapicque F, Bannwarth B, et al. Diffusion of intramuscular ketoprofen into the cerebrospinal fluid. Eur J Clin Pharmacol. 1985; 29: 319.PubMedCrossRefGoogle Scholar
  52. 52.
    Orme M, Baber N, Keenan J, et al. Pharmacokinetics and biochemical effects in responders and non-responders to nonsteroidal anti-inflammatory drugs. Scand J Rheum. 1981; 39 (suppl): 19.CrossRefGoogle Scholar
  53. 53.
    Huskisson EC, Woolf DL, Balme HW, et al. Four new anti-inflammatory drugs: responses and variations. Br Med J. 1976; 1: 1048.PubMedCrossRefGoogle Scholar
  54. 54.
    Gall EP, Caperton JF, McComb JE, et al. Clinical comparison of ibuprofen, fenoprofen calcium, naproxen, tolmectin sodium in rheumatoid arthritis. J Rheumatol. 1982; 9: 402.PubMedGoogle Scholar
  55. 55.
    Heller CA, Ingelfinger JA, Goldman P. Nonsteroidal anti-inflammatory drugs and aspirin—analyzing the scores. Pharmacotherapy. 1985; 5: 30.PubMedGoogle Scholar
  56. 56.
    Watson PG, Hayreh SS. Scleritis and epi-scleritis. Br J Ophthalmol. 1976; 60: 163.PubMedCrossRefGoogle Scholar
  57. 57.
    Bjarnason I, Zanelli G, Prowse P, et al. Blood and protein loss via small intestinal inflammation induced by nonsteroidal anti-inflammatory drugs. Lancet. 1987; 2: 711.PubMedCrossRefGoogle Scholar
  58. 58.
    Henry DA. Side effects of nonsteroidal antiinflammatory drugs. Baillieres Clin Rheumatol. 1988; 2: 425.PubMedCrossRefGoogle Scholar
  59. 59.
    Beard K, Walker AM, Perera DR, Jick H. Nonsteroidal anti-inflammatory drugs and hospitalization for gastroesophageal bleeding in the elderly. Arch Intern Med. 1987; 147: 1621.PubMedCrossRefGoogle Scholar
  60. 60.
    Sommerville K, Faulkner G, Langman M. Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer. Lancet. 1986; 1: 462.CrossRefGoogle Scholar
  61. 61.
    Hawkey CJ. Non-steroidal anti-inflammatory drugs and peptic ulcers. Br Med J. 1990; 300: 278.CrossRefGoogle Scholar
  62. 62.
    Soil AH. Pathogenesis of peptic ulcer and implication for therapy. N Engl J Med. 1990; 322: 909.CrossRefGoogle Scholar
  63. 63.
    Garella S, Matarese RA. Renal effects of prostaglandins and clinical adverse effects of nonsteroidal anti-inflammatory agents. Medicine. 1984; 64: 165.Google Scholar
  64. 64.
    Lifschitz MD. Prostaglandins and renal blood flow: in vivo studies. Kidney Int. 1981; 19: 802.CrossRefGoogle Scholar
  65. 65.
    Mondino BJ, Phinney RB. Treatment of scleritis with combined oral prednisone and indomethacin therapy. Am J Ophthalmol. 1988; 106: 473.PubMedGoogle Scholar
  66. 66.
    Foster CS. Immunosuppressive therapy for external ocular inflammatory disease. Ophthalmology. 1980; 87: 140.PubMedGoogle Scholar
  67. 67.
    Rao NA, Patchett R, Fernandez MA, et al. Treatment of experimental granulomatous uveitis by lipoxygenase and cyclo-oxygenase inhibitors. Arch Ophthalmol. 1987; 105: 413.PubMedGoogle Scholar
  68. 68.
    Howes EL, McKay DG. The effect of aspirin and indomethacin on the ocular response to circulating bacterial endotoxin in the rabbit. Invest Ophthalmol. 1976; 15: 648.PubMedGoogle Scholar
  69. 69.
    Olson NY, Lindsley CB, Godfrey WA. Nonsteroidal anti-inflammatory drug therapy in chronic childhood iridocyclitis. Am J Dis Child. 1988; 142: 1289.PubMedGoogle Scholar
  70. 70.
    Nussenblatt RB, Palestine AG. Philosophy, goals, and approaches to medical therapy. In: David K. Marshall, ed. Uveitis. Fundamentals and Clinical Practice. Chicago: Year Book Medical Publishers; 1989: 104.Google Scholar
  71. 71.
    Dinning WJ. Therapy—selected topics. In: Kraus-Mackiw E, O’Connor GR, eds. Uveitis. Pathology and Therapy. 2nd rev. ed. New York: Thieme Medical Publishers; 1986: 204.Google Scholar
  72. 72.
    Fauci AS. Clinical aspects of immunosuppression: use of cytotoxic agents and corticosteroids. In: Bellanti IA, ed. Immunology II. Philadelphia: WB Saunders; 1978.Google Scholar
  73. 73.
    Wong VG. Methotrexate treatment of uveal disease. Am J Med Sci. 1966; 251: 239.PubMedGoogle Scholar
  74. 74.
    Wong VG. Immunosuppressive therapy of ocular inflammatory diseases. Arch Ophthalmol. 1969; 81: 628.PubMedGoogle Scholar
  75. 75.
    Foster CS. Immunosuppressive therapy for external ocular inflammatory disease. Ophthalmology (Rochester). 1980; 87: 140.Google Scholar
  76. 76.
    Buckley CE III, Gills JP Jr. Cyclophos-phamide therapy of Behcet’s disease. J Allergy. 1969; 43: 273.PubMedCrossRefGoogle Scholar
  77. 77.
    Buckley CE III, Gills JP Jr. Cyclophosphamide therapy of peripheral uveitis. Arch Intern Med. 1969; 124: 29.PubMedCrossRefGoogle Scholar
  78. 78.
    Andrasch RH, Pirofsky B, Burns RP. Immunosuppressive therapy for severe chronic uveitis. Arch Ophthalmol. 1978; 96: 247.PubMedGoogle Scholar
  79. 79.
    Newell FW, Krill AE. Treatment of uveitis with azathioprine (Imuran). Trans Ophthalmol Soc UK. 1967; 87: 499.PubMedGoogle Scholar
  80. 80.
    Palacios R, Moller G. Cyclosporin A blocks receptors for HLA-DR antigens on T cells. Nature. 1981; 290: 792.PubMedCrossRefGoogle Scholar
  81. 81.
    Beveridge T. Pharmacokinetics and metabolism of cyclosporin A. In: White DJG, ed. Cyclosporin A. New York: Elsevier Biomedical Press; 1982: 35.Google Scholar
  82. 82.
    Nussenblatt RB, Palestine AG. Cyclosporine: immunology, pharmacology, and therapeutic uses. Surv Ophthalmol. 1986; 31: 159.PubMedCrossRefGoogle Scholar
  83. 83.
    Bunjes D, Hardt C, Rollinghoff M, et al. Cyclosporin A mediates immunosuppression of primary cytotoxic T cell respones by impairing the release of interleukin 1 and interleukin 2. Eur J Immunol. 1981; 11: 657.PubMedCrossRefGoogle Scholar
  84. 84.
    Kaufman Y, Chang AE, Robb RJ, et al. Mechanism of action of cyclosporin A: inhibition of lymphokine secretion studied with antigen-stimulated T-cell hybridomas. J Immunol. 1984; 133: 3107.Google Scholar
  85. 85.
    Bendtzen K, Dinarello CA. Mechanism of action of cyclosporine A. Scand J Immunol. 1984; 20: 43.PubMedCrossRefGoogle Scholar
  86. 86.
    Nussenblatt RB, Palestine AG, Chan CC. Cyclosporin A therapy in the treatment of intraocular inflammatory disease resistant to systemic corticosteroids and cytotoxic agents. Am J Ophthalmol. 1983; 96: 275.PubMedGoogle Scholar
  87. 87.
    Nussenblatt RB, Palestine AG, Rook AH, et al. Treatment of intraocular inflammatory disease with cyclosporin A. Lancet. 1983; 2: 235.PubMedCrossRefGoogle Scholar
  88. 88.
    Nussenblatt RB, Palestine AG, Chan CC. Cyclosporine therapy for uveitis: long-term follow-up. J Ocular Pharmacol. 1985; 1: 369.CrossRefGoogle Scholar
  89. 89.
    Feutren G, Mihaatsch MJ. Risk factors for cyclosporine-induced nephropathy in patients with autoimmune diseases. International Kidney Biopsy Registry of Cyclosporine in Autoimmune Diseases. N Engl J Med. 1992; 326: 1654.PubMedCrossRefGoogle Scholar
  90. 90.
    Austin HA III, Palestine AG, Sabnis SG, et al. Evolution of cyclosporin nephrotoxicity in patients treated for autoimmune uveitis. Am J Nephrol. 1989; 9: 392.PubMedCrossRefGoogle Scholar
  91. 91.
    Mochizuki M, Ikeda E, Shirao M, et al. Pre-clinical and clinical study of FK506 in uveitis. Curr Eye Res. 1992;ll(suppl):87.CrossRefGoogle Scholar
  92. 92.
    Mochizuki M, Masuda K, Sakane T, et al. A clinical trial of FK506 in refractory uveitis. Am J Ophthalmol. 1993; 115: 763.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York Inc. 1995

Authors and Affiliations

  • E. Mitchel Opremcak
    • 1
  1. 1.The Ohio State UniversityColumbusUSA

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