acute iritis: 1 drop of pred forte/day for maintenance?

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vancouver
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acute iritis: 1 drop of pred forte/day for maintenance?

Post by vancouver » Tue Dec 01, 2015 8:45 pm

My eye surgeon tapered me off steroids but optometrist put me on maintenance dose of 1 drop per day of 1% pred forte. He says research suggests this lowers probability of recurrence.
Is he lying? I suspect i have a few cells in anterior chamber?

kwork
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by kwork » Tue Dec 01, 2015 9:37 pm

No he is right, it takes time for an iritis flare up to calm down. It's like a snowball effect and will continue to get worse unless it stops. So you want to make sure the inflammation has completely calmed in your eye before you stop the medication.

I've also learned the faster you can treat it the sooner the inflammation stops. Doctors would hate it when I would self diagnose and put drops in before my visit. I couldn't sit a couple days waiting for an appointment. Time is against you during a flare up.
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vancouver
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by vancouver » Wed Dec 02, 2015 12:52 am

Thank you for your response, kwork. I guess he is lying then. He's insinuating that there are no cells and that the one drop per day is just insurance.
I'll have to get copy of my records to find out what these guys are up to;) I was on 24 drop/day for 30 days per the eye surgeon and then placed in hands of optomotrist. If i still have cells, i would think the treatment should be more aggressive.

kwork
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by kwork » Wed Dec 02, 2015 9:32 am

I wouldn't say he is lying, the last thing either one of you want is for it to come back. He's looking for scientific proof through a microscope and using best practices to treat you. You are the only one that can give him feedback on the symptoms and pain you are having. I'm not a doctor and don't get to see the same things he does on a daily basis, but I build trust with any doctor I use. If there is a trust issue you need to find a new specialist.
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vancouver
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by vancouver » Thu Dec 03, 2015 3:58 am

Thanks, kwork :) its hard to find doctors in my area. They are getting rich doing cataract surgery on baby boomers and no intetest in iritis. . Thanks for the help.

Ps looked at dr fosters algorithm fir nongranulomitous iritis and see no mention of steroids for maintenance.

Mike Bartolatz
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by Mike Bartolatz » Tue Dec 08, 2015 2:40 pm

it might be more appropriate to go to an NSAID such as Celebrex, Dolobid or Naproxen at prescription strength for six months to see if it can quiet your eyes down. if it does you say at prescription strength for two years before tapering off.

personally I would NOT stay on a drop a day indefinitely but would slowly taper off of the steroid eye drop. even a drop a day can eventually lead to cataract formation over time. cataract surgery is TRAUAM to the eye and will often cause renewed inflammation of uveitis that is very difficult to calm down. I speak for my own case of uveitis. I would also have an ophthalmologist not an optometrist whom I trust as the caretaker of my uveitis but I would also get an EXPERT involved not just a run of the mill ophthalmologist if at all possible.

if you are in Vancouver Washington, get Dr Rosenbaum as your ocular immunologist at Casey eye Instutute in Portland, Oregon.
if you are in Vancouver Canada, get DR Wade as your uveitis specialist.

they can help find out the underlying cause and then use the appropriate drugs.

if your uveitis is in one eye and keeps coming back and you have a history of cold sores on your lips, mouth or nose, consider the herpes Sx virus as a cause and then antiviral and the one drop a day of steroid might be appropriate.

if you are HLA B27 positive, then an NSAID might help break the recurrent cycle.

if you have ankylosing spondylitis, reactive arthritis, psoriasis/psoriatic arthritis, Crohn's disease or ulcerative colitis, DMARD drugs might be required such as methotrexate, Cellcept or Imuran alone or in combination with Humira or Remicade.

if these drugs don't work then there are many other drugs to employ but it takes and EXPERT to figure this stuff out.

there are over 85 different causes of uveitis many of which are from pathogens and most doctors never consider them so you cannot trust an 'ideopathic' diagnosis from a general ophthalmologist in many instances and an optometrist has even less knowledge about causes of uveitis. this is a RARE disease process that you have. general practice medicine will NOT get you the care you require. they most often have no experience in diagnosis and treatment of uveitis or it's cause and cannot prescribe the Disease modifying drugs required to get you to REMISSION.

Wish you the very best,
Mike Bartolatz
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kwork
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by kwork » Tue Dec 08, 2015 2:58 pm

I don't want to hijack a thread topic but curious on Cellcept and Imuran. Mike do you have experience with either.
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Arthur
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by Arthur » Mon Jan 08, 2018 7:22 pm

What about a drop of Acuvail a day indefinitely ? My eye doctor have me using a one time use vial of Acuvail for a drop a day for two days. He said it's ok to use leftover in the vial for use the next day to economize. Is this a tried and tested way of getting rid of persistent cells?

vancouver
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Re: acute iritis: 1 drop of pred forte/day for maintenance?

Post by vancouver » Wed Jan 10, 2018 11:49 pm

Arthur wrote:What about a drop of Acuvail a day indefinitely ? My eye doctor have me using a one time use vial of Acuvail for a drop a day for two days. He said it's ok to use leftover in the vial for use the next day to economize. Is this a tried and tested way of getting rid of persistent cells?
Some docs still use acuvail. Studies suggest topical nsaids don't work. You won't get a definite answer. Studies are expensive and hard to conduct properly. Grey area. Steroid drops for maintenance have been shown to work. Everyone is different. You may be very stable. Time will tell.

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