Matthew D Spangler, Nila Kirupaharan, John D Sheppard
INTRODUCTION: Uveitis encompasses a heterogeneous group of inflammatory disorders affecting the iris, ciliary body, and choroid and remains a leading cause of preventable blindness worldwide. Although corticosteroids have historically served as first-line therapy, long-term exposure is associated with ocular morbidity. The Multicenter Uveitis Steroid Treatment trials were pivotal in redefining management paradigms by demonstrating equivalent visual outcomes between systemic therapy and intraocular steroid implants while highlighting the significant ocular complications associated with sustained local corticosteroid delivery. These findings accelerated the transition toward steroid-sparing and targeted immunomodulatory strategies.
AREAS COVERED: This narrative review synthesizes major advances in uveitis pharmacotherapy using a treat-by-target framework that aligns therapy with anatomical involvement and underlying pathophysiology. We reviewed developments in topical corticosteroids and examined the evolution of intravitreal corticosteroid implants. Steroid-sparing approaches are discussed, including conventional immunomodulatory therapy, biologic agents, repository corticotropin injection, and emerging small-molecule therapies.
EXPERT OPINION: The next decade of uveitis management will prioritize precision pharmacology aimed at sustained inflammation control while minimizing corticosteroid-associated toxicity. Advances in molecular targeting, novel sustained-release delivery systems, earlier biologic intervention, and improved diagnostic and imaging technologies will further enable individualized, mechanism-driven therapy.