Despite their side-effects and the advent of systemic immunosuppressives and biologics, the use of corticosteroids\r\nremains in the management of patients with uveitis, particularly when inflammation is associated with systemic\r\ndisease or when bilateral ocular disease is present. The use of topical corticosteroids as local therapy for anterior\r\nuveitis is well-established, but periocular injections of corticosteroid can also be used to control mild or moderate\r\nintraocular inflammation. More recently, intraocular corticosteroids such as triamcinolone and steroid-loaded vitreal\r\ninserts and implants have been found to be effective, including in refractory cases. Additional benefits are noted\r\nwhen ocular inflammation is unilateral or asymmetric, when local therapy may preclude the need to increase the\r\nsystemic medication.\r\nImplants in particular have gained prominence with evidence of efficacy including both dexamethasone\r\nand fluocinolone loaded devices. However, an appealing avenue of research lies in the development of\r\nnon-corticosteroid drugs in order to avoid the side-effects that limit the appeal of injected corticosteroids.\r\nSeveral existing drugs are being assessed, including anti-VEGF compounds such as ranibizumab and bevacizumab,\r\nanti-tumour necrosis factor alpha antibodies such as infliximab, as well as older cytotoxic medications such as\r\nmethotrexate and cyclosporine, with varying degrees of success. Intravitreal sirolimus is currently undergoing phase\r\n3 trials in uveitis and other inflammatory pathways have also been proposed as suitable therapeutic targets.\r\nFurthermore, the advent of biotechnology is seeing advances in generation of new therapeutic molecules such as\r\nhigh affinity binding peptides or modified high affinity or bivalent single chain Fab fragments, offering higher\r\nspecificity and possibility of topical delivery.
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