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
|
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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