Background/Purpose: In uveitis rapid and effective remission-inducing therapy is mandatory to avoid irreversible structural and functional damage.Our aim was to evaluate the efficacy and safety of high-dose intravenous methylprednisolone (IVMP) pulse therapy in a broad spectrum of uveitis.

Methods: Multicentre study of 120 patients (190 eyes) with severe ocular inflammation who received IVMP. The underlying diseases were: Idiopathic (n=34), Vogt Koyanagy Harada (28),Behçet disease (19), Sarcoidosis (6), Multifocal Choroidopathy (4), Birdshot chorioretinopathy (2), Acute posterior multifocal placoid pigment epitheliopathy (1), Granulomatosis with polyangiitis (2), Aortitis (1), Rheumatoid arthritis (2), Axial Spondylitis (6), Psoriatic arthritis (2), Juvenile Idiopathic Arthritis (1), Eales Disease (1), Sympathetic Ophthalmia (3), Multiple Sclerosis (2), Relapsing Polychondritis (1), Cogan’s synd. (1), Sjögren synd.(2), Crohn’s disease (1) and Reactive arthritis (1). The inflammatory ocular patterns were: panuveitis (62), posterior uveitis (PU) (29), intermediate uveitis (IU) (3), anterior uveitis (AU) (12), AU and PU (2), AU and IU (1), IU and PU (1), exudative retinal detachment (4), retinal vasculitis (2), pseudotumor (1), scleritis (2) and sclero-uveitis (1). Bilateral ocular involvement was observed in 70 patients. Patients were assessed at basal visit and day 2-5, 7, 15 and 30 after IVMP.

The main outcome variable was best corrected visual acuity (BCVA), the degree of inflammation of the anterior chamber and vitreous, and macular thickness (macular edema defined by OCT >300 μm). The results are expressed as mean ±SD for normally distributed variables, or as median [interquartile range] when are not. Comparison of continuous variables was performed using the Wilcoxon test.

Results: We studied 70 ♀/ 50 ♂; mean age 42 ±14.46 years. IVMP dose ranged from 40-1000 mg/day for 3-5 consecutive days. All of them had active intraocular inflammation. Prior to IVMP, cycloplegic and corticosteroid eye drops were used in all cases. Improvement was faster among patients with inflammation in anterior chamber and vitritis than in BCVA, CME, retinitis and retinal vasculitis (TABLE 1). Total remission was achieved in 17.5% of the 120 patients after IVMP. In 118 of the patients continued with oral corticosteroids and 4 received an intraocular dose of corticosteroids. The following conventional immunosuppressive drugs were added: Methotrexate (50), Cyclosporine A (47), Azathioprine (37) and others (5). In a few cases even biological therapy (61) was administered afterwards. In general, acute respiratory infection was the side-effect most frequent.

Conclusion: High-dose IVMP pulse therapy is beneficial in the prompt control of severe uveitis and it is well tolerated.

TABLE 1.

*p <0.05 compared with basal