Treatment protocol questions

[orthowmn]

In the past 16 months, I have had unilateral iritis in my left eye 3 times. Each bout was treated and resolved with Pred Forte and Homatropine. My ophthalmologist was not too interesting in tracking down the etiology, but I spoke with my GP who ordered a number of blood tests. My results came back HLA B27 positive. So here's my question: in the absence of any other problems (e.g. arthopathies) does the treatment regimen change? Specifically, is there a protocol for deciding when you switch from treating incidents as they arise to preventive measures?

[Mike Bartolatz]

it is most likely that this will keep recurring over and over again and topical steroids cannot put you into durable remission. if you can take NSAIDS. ask your doctor to put you on one for a trial to see if this can stop the recurrent nature of HLA B27 related iritis before it starts ping ponging between eyes. Dr Foster at the Ocular Immunology and Uveitis Foundation in Cambridge, MA uses Cellebrex, Difusinal or Naproxen at prescription strength and slowly tapers the steroid eyedrops. if the eye is quiet in six months, then he continues for TWO YEARS on the NSAID. then he slowly tapers off the NSAID. should the iritis return during this period of time, he usually switches to a DMARD drug such as methotrexate, cellcept or Imuran and the process starts again. slowly increasing the DMARD drug until the eye is quiet and you have tapered off of the Steroid. the waiting time is once again TWO YEARS on the DMARD drug so that the immune system stops replicating the cells which cause the inflammatory processes to occur,
your local ophthalmologist most likely doesn NOT know how to do this as the run of the mill ophthalmologists are not trained to do this. Ocular immunologists are trained at various University Medical Schools through advanced training in this process. I stronly urge you to get one involved in your care if at all possible. most opthalmologist say, 'if steroids cause cataracts we can operate on them'. or, if glaucoma develops we can treat that or do surgery. why not stop this process before you eyes are damaged in the first place?

there is a list of these specialists at http://www.uveitis.org in the patient information section of the site, you may have to travel however as they are not in every city or even every State in the USA. if you will tell me where you live I can suggest the best one nearest to you so that you can end this ordeal once and for all.

wishing you the very best,
Mike Bartolatz

[orthowmn]

I live in Florida and have looked into seeing one of the ocular immunologists at Bascom Palmer is Miami. Who would you recommend?

[Mike Bartolatz]

either DR Janet Davis or DR Perez who studied under Dr Foster at Harvard.

take care,
Mike