Methylprednisolone pulse therapy in severe anterior uveitis

Six patients with severe, refractory anterior uveitis (AU) were treated with intermittent, intravenous pulses of methylprednisolone (MP). Five patients had bilateral AU and all had decreased visual acuities. AU was idiopathic in four subjects, one male had ankylosing spondylitis (HLA-B27 +) and one female had juvenile polyarthritis. All patients were initially treated with 1 g of MP intravenously (IV) on alternate days during the first week. Subsequently, patients received weekly injections of MP on a reducing dosage regime to a maintenance dose of 125 mg IV weekly. This therapy produced a rapid resolution of the signs of uveal inflammation and improved visual acuity. Two patients have been maintained on this treatment regime for over 12 months without evidence of disease relapse or serious drug side effect. Pulse MP is effective in the treatment of severe anterior uveitis and may be a useful adjunct in the management of patients with uveitis.