چكيده لاتين :
The success of corticosteroids in the treatment of ocular inflammation catalyzed a search for better synthetic analogues with more potent anti-inflammatory effects, better ocular penetration, and enhanced bioavailability. At present, corticosteroids remain the mainstay of management of ocular inflammatory and immune-mediated diseases. Numerous studies have clearly shown that tissue edema, including retinal edema in uveitis, can be improved by corticosteroids and it also may be possible to modify the course of diabetic macular edema with steroids. Steroid compounds have recently been shown to have antiangiogenic effects in patients with wet type age-related macular degeneration. Topical corticosteroid preparations include dexamethasone, prednisolone, fluorometholone, medrysone, medroxyprogesterone, rimexolone, lodeprednol etabonate. Corticosteroids used for systemic, regional and intravitreal therapy including hydrocortisone, prednisone, prednisolone, methyl prednisolone, triamcinolone, dexamethasone, betamethasone, fluocinolone acetonide, anecortave acetate. Adverse neuropsychiatric and endocrine effects are the most common complications attributed to corticosteroids. Pathologic fractures involving the hip and spine are other complications. The most clinically significant ocular complications of corticosteroid therapy are development of cataract and secondary glaucoma. Other important adverse effects produced by all routes of corticosteroid administration include mydriasis, ptosis, and susceptibility to infection, impaired wound healing and paradoxical anterior uveitis. Corticosteroids are contraindicated in patients with systemic fungal infection or known hypersensitivity to the drug formulation and should be used with great caution in patients with history of excessive alcohol consumption, peptic ulcer, a variety of infectious diseases, diabetes mellitus, severe hypertension or congestive heart failure, psychiatric problems, osteoporosis, in children and during pregnancy and breastfeeding. Steroids are metabolized by hepatic microsomal enzymes. Concurrent use of some drugs may decrease the pharmacologic effects of corticosteroids; these include phenobarbital, phenytoin, carbamazepine, ephedrine, rifampin, cholestyramine, and high dose antacids. In contrast, some other agents may augment pharmacologic effects of steroids: cyclosporin, indometacin, naproxen, isoniazid, ketoconazole, oral contraceptives, methotrexate, and cyclophosphamide.
