Increased interest in immunological diseases in recent years, which has accompanied advances in tissue grafting and cancer research, has led to attempts to treat uveitis with means other than steroids. Immunosuppressive agents, such as cyclosporin A, tacrolimus, azathioprine, and cyclophosphamide, are now sometimes used to supplement or replace steroids in difficult cases. If posterior uveitis is not due to any recognisable infective cause, it is usual to start treatment with systemic steroids if the visual acuity becomes significantly impaired or if the lesion is close to the macula. Large doses of systemic steroids are best administered on an inpatient basis, especially if the sight is threatened. This has the added advantage of allowing a more detailed pretreatment examination and investigations, and often the opinion of a general physician or immunologist can be valuable at this stage. Secondary glaucoma might also need to be treated and immunosuppressive agents can be administered to resistant cases. When posterior uveitis keeps recurring at the edge of previous healed foci, laser coagulation has been used in selected patients with toxoplasma retinocho-roiditis. The rationale of this treatment is to destroy any remaining encysted organisms.
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