Comparison of Topical versus Systemic Steroids in Uveitis Management
1Tahmoor Shah, 2Marwa Abbas, 3 Dr Khalid Rafique, 4Hammad Javed, 5Khizar Butt, 6Ali Murad
1Services Hospital Lahore
2UHS
3Assistant professor ophthalmology, Rashid latif medical college, Lahore.
4PIMS
5UHS
6 Services Hospital Lahore
Vol: 16/03, 621-627
Submission: 05 June 2025 | Acceptance: 29 Nov 2025 | Publication: 07 Dec 2025
Abstract
Background: Corticosteroids—topical and systemic—remain the mainstay for controlling intraocular inflammation in uveitis, but comparative data on efficacy, intraocular pressure (IOP) effects, systemic adverse events, and time to resolution vary. Objective: To compare clinical efficacy and safety of topical steroid therapy versus systemic steroid therapy in patients with non-infectious anterior and intermediate uveitis. Methods: Prospective, randomized, open-label study of 200 patients with active non-infectious uveitis randomized 1:1 to topical steroid therapy (prednisolone acetate 1% eye drops, tapered) or systemic oral prednisolone (initial 1 mg/kg tapered). Primary outcome was complete resolution of intraocular inflammation at 4 weeks. Secondary outcomes included time to resolution, change in best-corrected visual acuity (BCVA), incidence of IOP elevation (>21 mmHg), and systemic adverse events. Statistical tests: chi-square for categorical variables and t-test for continuous variables; significance set at p < 0.05.
Results: 200 patients (100 topical, 100 systemic) completed 12-week follow-up. Resolution at 4 weeks: topical 78/100 (78%), systemic 85/100 (85%) (p = 0.18). Mean time to resolution: topical 18.2 ± 6.1 days’ vs systemic 14.5 ± 5.3 days (mean difference 3.7 days; p = 0.04). BCVA improvement ≥2 lines at 8 weeks: topical 60%, systemic 68% (p = 0.19). IOP elevation occurred more frequently in the topical group (22% vs 10%; p = 0.02). Systemic adverse events (transient hyperglycemia, weight gain, mood changes) were higher in the systemic group (18% vs 2%; p < 0.001). Conclusion: Both topical and systemic corticosteroid regimens achieve high rates of inflammation control in non-infectious uveitis. Systemic steroids demonstrated a slightly faster resolution and trend toward higher vision gain, while topical steroids were associated with greater IOP elevation. Choice of therapy should balance desired speed of control and the patient’s systemic risk profile; combined or adjunctive immunomodulatory strategies may be considered where appropriate. Keywords: Comparison, Topical, Systemic, Steroids, Uveitis Management.