The gold standard of noninfectious uveitis: corticosteroids

Corticosteroids (CS) are considered to be the mainstay of therapy in noninfectious uveitis. They can be administered only after excluding an infectious origin or a possible masquerade syndrome. Different CS preparations can be used with various modes of administration: topical, periocular, intraocular, systemic or a combination of the above routes. Their indications depend upon numerous factors, among them the type (involving or not the posterior segment), the severity, the uni-/bilaterality, the chronicity of the intraocular inflammation. The induction treatment must be aggressive in order to overcome the intraocular inflammation as rapidly as possible avoiding permanent tissue damage. The dosage regimen is then tapered according to the clinical response and after a minimum period of quiescence. The maintenance CS treatment should not exceed 6-12 months under the threat of severe adverse effects. In chronic cases, high-dosage CS monotherapy cannot be used; it is important to add an immunomodulatory treatment on time when a long-term therapy is needed to control the disease. Although CS represent the first line of treatment, the type of clinical response to CS is not a reliable indicator of the effectiveness of immunomodulation: a noninfectious uveitis unresponsive to CS may respond to immunomodulation alone or combined with CS.