Exploring balance of controlling inflammation, IOP in uveitis
Steroids may bring rapid control, but patients who need long-term suppression should be switched to immunosuppressives
Take-home message: Clinicians need to weigh such factors as inflammation and IOP in determining when steroid therapy is beneficial in uveitic glaucoma.
Los Angeles—Corticosteroids can be the best and the worst treatment for elevated IOP.
In the short term, corticosteroids alone may reduce IOP in a limited group of disorders during exacerbations of inflammation. But long-term use of those same corticosteroids can boost IOP, exacerbating uveitic glaucoma in patients with chronic forms of uveitis.
“Corticosteroid-induced ocular hypertension is a problem, but it is not the only pressure problem in people with uveitis,” said Gary N. Holland, MD.
“Uveitic glaucoma, glaucoma attributed to uveitis itself, is an even bigger problem. Don’t assume that all elevated pressure is due to steroids,” said Dr. Holland, professor of ophthalmology, University of California Los Angeles Stein Eye Institute. “Cutting back on steroids and letting ocular inflammation smolder at a low grade is counterproductive because it will result in more ocular damage, leading to even worse problems with glaucoma.”
Keeping inflammation under control
Dr. Holland discussed the complications of treating the inflammation associated with uveitis and uveitic glaucoma.
Corticosteroids are the preferred agents to bring inflammation under control rapidly, he noted. But patients who need long-term suppression of inflammation should be switched to immunosuppressive agents.
While uveitic glaucoma is more common in children than it is in adults, the considerations and strategies used to manage the condition are similar. The onset of uveitic glaucoma is earlier in children than it is in adults and tissue damage progresses more rapidly in children. The manifestations of uveitic glaucoma are more severe in children and the risk of glaucoma is directly related to the severity of uveitis. At the same time, children have an increased risk for ocular hypertension associated with corticosteroids.
The end result, Dr. Holland said, is that while children have the greater need for quick and complete control of inflammation, they are also at higher risk for elevated IOP due to steroid response.