Corticosteroids in uveitis.
No strong evidence exists with which to answer questions about the effectiveness of CS in treating visual loss from intraocular inflammation. Steroids are valuable and quickly working anti-inflammatory medications, which may prevent visual loss in many patients with noninfectious uveitis. The value of prolonged treatment in uveitis is not yet established. The literature on efficacy of CS in diverse uveitic entities contains no results from randomized clinical trials; all of the information originated from case series. In addition, a quality of life assessment was not studied. These are serious limitations; the information about the effect of medication should be obtained by comparing a treated group with an untreated control group similar in all the important respects. Necessary documentation would include details about the patient selection criteria. Use of standardized follow-up intervals and outcomes assessment would further improve the quality of information, as would comparisons with the natural history of the untreated patient population. Because case series have no control group and do not use randomization, there is no way to estimate how CS might have changed a final outcome. Because of the severe adverse effects associated with chronic use of CS and unknown efficacy on final visual prognosis, it is recommended for those of need of long-term anti-inflammatory medication to start CS in the acute stage of the disease and taper off subsequently with use of CS-sparing medications. Randomized clinical trials are needed to determine the short- and long-term effectiveness of CS in uveitis.
Rothova
Aniki
A
Uveitis Center, FC Donders Institute of Ophthalmology, University Medical Center Utrecht, E.03-136, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. A.Rothova@azu.nl
D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D014605:Uveitis / Q000150:complications / Q000188:drug therapy*; D014786:Vision Disorders / Q000188:drug therapy / Q000209:etiology
D005938:Glucocorticoids