title: A comprehensive review and update on the non-biologic treatment of adult noninfectious uveitis: part I.
abstract: BACKGROUND
  Treatment of adult, noninfectious uveitis remains a challenge for ophthalmologists around the world. The disease accounts for almost 10% of preventable blindness in the US and can be idiopathic or associated with infectious and systemic disorders. Strong evidence is still emerging to indicate that pharmacologic strategies presently used in rheumatologic or autoimmune disease may be translated to the treatment of intraocular inflammation. Corticosteroid monotherapy is widely regarded as wholly inappropriate, due to the unfavorable risk/benefit profile and poor long-term outcomes. Treatment plans have shifted away from low-dose, chronic corticosteroid therapy for maintenance, towards medium- to high-dose therapy for acute inflammation, followed immediately by initiation of immunomodulatory therapy. These therapies follow the 'stepladder approach', whereby least to more aggressive therapies are trialed to induce remission of inflammation, eventually without corticosteroids of any form (topical, local and systemic).
  
  
  METHODS
  This two-part review gives a comprehensive overview of the existing medical treatment options for patients with adult, noninfectious uveitis, as well as important advances for the treatment of ocular inflammation. Part I covers classic immunomodulation and latest information on corticosteroid therapy.
  
  
  CONCLUSIONS
  The hazard of chronic corticosteroid use for the treatment of adult, noninfectious uveitis is well-documented. Corticosteroid-sparing therapies, which offer a very favorable risk-benefit profile when administered properly, should be substituted.
authors.affiliation: Massachusetts Eye Research and Surgery Institution , 5 Cambridge Center, 8th Floor, Cambridge, MA 02142 , USA +1 617 621 6377 ; +1 617 494 1430 ; sfoster@mersi.com.
authors.forename: Kyungmin
authors.initials: K
authors.lastname: Lee
authors.forename: Asima
authors.initials: A
authors.lastname: Bajwa
authors.forename: Clovis A
authors.initials: CA
authors.lastname: Freitas-Neto
authors.forename: Jamie Lynne
authors.initials: JL
authors.lastname: Metzinger
authors.forename: Bailey A
authors.initials: BA
authors.lastname: Wentworth
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000477:Alkylating Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000963:Antimetabolites / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy; D014605:Uveitis / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D000477:Alkylating Agents; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000963:Antimetabolites; D005938:Glucocorticoids; D007155:Immunologic Factors
keywords: classic immunomodulators; corticosteroid; immunomodulatory therapy; ocular inflammatory disease; uveitis