Complications And Prognosis

Uveitis has numerous complications, which often cause visual loss. Treatment of uveitis can also contribute to these complications. Glaucoma may arise from a pressure response

TABLE 2 Immunosuppressive Therapy in Uveitis, Cogan's Syndrome, and Sarcoidosis

Drug

Dose

Major side effects

Hydroxychloroquine

100-400 mg daily

Retinopathy, nausea, rare neuromyopathy

Methotrexate

10-25 mg/wk

Nausea, mouth sores, hair loss, cytopenias, liver test abnormalities, rash, liver fibrosis, rare pneumonitis

Azathioprine

1-3mg/kg daily

Nausea, infection, arthralgia, cytopenias, rash, rare lymphoreticular neoplasm

Mycophenolate

0.5-1 g twice daily

Diarrhea, nausea, constipation, dyspepsia,

mofetil

abdominal pain, anorexia, low blood counts, rash, risk of hematologic malignancy

Cyclosporine

2-4 mg/kg daily

Nephrotoxicity, hypertension, hirsutism, gingival hyperplasia, hypomagnesemia, infection, secondary malignancy

Cyclophosphamide

1 -2 mg/kg daily

Low blood counts, nausea, infection, hemorrhagic cystitis, bladder cancer, hair loss, sterility, secondary malignancy, teratogenicity

Chlorambucil

0.1-0.2 mg/kg daily

Low blood counts, sterility, teratogenicity, secondary malignancy

Etanercept

50 mg SQ weekly

Injection site reactions, headaches, nasal and sinus congestion, risk of tuberculosis

Infliximab

200-800 mg every

Headaches, nasal and sinus congestion,

8 wk

decrease in BP, rash, risk of tuberculosis, rare lymphoma

Adalimumab

40 mg SQ twice a

Injection site reactions, headaches, nasal and sinus

month or weekly

congestion, risk of tuberculosis

Abbreviation: SQ, subcutaneous.

Abbreviation: SQ, subcutaneous.

to corticosteroid therapy; cataracts may develop from long-term use of these agents. Appropriate management of these complications provides the best opportunity for avoiding adverse visual outcomes. Band keratopathy is a complication specifically associated with JRA and is treated by chelation and excimer laser (Fig. 1D). CME is the most common cause of decreased visual acuity in patients with posterior uveitis (Fig. 1E). Finally, other complications may result from systemic treatments (1,14,16).

Prognosis is best in patients with anterior uveitis. In one study, 4% of patients with anterior uveitis lost at least 25% of visual acuity, while 43% and 40% of patients with posterior uveitis and panuveitis, respectively, developed this complication (2).

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