Use of steroids and immunosuppressive drugs in the management of posterior uveitis.

Posterior uveitis can occur in all age-groups and often has devastating effects on vision. The visual loss can have a variety of causes including cataract formation, vitritis, optic nerve damage and macular oedema. In patients with active inflammatory disease resulting in reduced vision, steroids are still the best drug but cyclosporin is becoming widely used in combination with steroid therapy, in patients who do not respond to steroids alone or in whom the dose of steroids required to control the disease process is unacceptably high. Cyclosporin works specifically on activated T-lymphocytes and does not therefore result in bone marrow suppression like the more conventional immunosuppressive drugs. This paper discusses the indications for treatment in patients with posterior uveitis and how to use steroids, cyclosporin and other immunosuppressive drugs in the management of this condition.