TREATMENT STRATEGIES FOR SCLERITIS AND UVEITIS ASSOCIATED WITH INFLAMMATORY BOWEL-DISEASE

We treated 19 patients with anterior uveitis, episcleritis, or sclerit is associated with inflammatory bowel disease. Adequate control of ocu lar inflammation was achieved in 16 patients (84%). Ocular inflammatio n was adequately controlled with corticosteroids alone, without system ic adverse effects, in only three patients, all of whom had anterior u veitis associated with ulcerative colitis. Systemic nonsteroidal anti- inflammatory drugs proved beneficial in six of seven patients, and one additional patient benefited from another anti-inflammatory drug (hyd roxychloroquine sulfate). Systemic cytotoxic immunosuppressive therapy was used in the remaining seven patients, six of whom had bilateral d isease. Ocular inflammation was controlled in six of these patients. A zathioprine was beneficial for scleritis but was less effective for an terior uveitis, especially in Crohn's disease, thus necessitating the use of another cytotoxic agent. HLA-B27-positive anterior uveitis was more refractory to corticosteroid therapy and was more likely to requi re systemic cytotoxic immunosuppressive therapy. With the medical and surgical strategies described, vision was improved or maintained in al l patients in the study group.