Adding oral prednisone was linked to HLA-B27 uveitis settling about two weeks sooner

Design

Retrospective single-centre cohort

Population

462 people with HLA-B27-associated acute anterior uveitis

Primary outcome

Time to complete control of anterior chamber inflammation

Effect

Median 28 vs 41 days; adjusted HR 2.19 (1.56–3.10)

This retrospective single-centre cohort included 462 people with HLA-B27-associated acute anterior uveitis seen between 2014 and 2025. At the first observed episode, 74 received topical corticosteroids plus oral prednisone and 388 topical steroids alone.

Median time to complete control of anterior chamber inflammation was 28 days with added prednisone versus 41 days with topical treatment alone. After adjustment, oral prednisone was the only variable associated with faster control (HR 2.19, 95% CI 1.56–3.10). Total time on treatment did not differ (62 vs 61 days). Prednisone for longer than 14 days gave no extra benefit. Starting with at least eight topical drops a day was associated with earlier discontinuation.

Since the sicker eyes probably received oral steroids, the true benefit may be larger than seen here. A short oral course, alongside intensive topical treatment from the start, is a reasonable option for a severe first attack — with blood glucose, blood pressure and TB risk considered before prescribing.

• Start intensive topical steroid at presentation, at least eight drops a day for a significant attack
• Consider a short oral prednisone course, up to 14 days, for severe HLA-B27 anterior uveitis
• Check glucose, blood pressure and TB risk before oral steroids
• Add cycloplegia and monitor intraocular pressure during treatment
• Ask about back pain, bowel and skin symptoms that suggest associated spondyloarthritis

Why it matters

Challenges the habit of reserving oral steroids for topical failure in acute anterior uveitis.

Don't overread it

A retrospective single-centre comparison; it does not prove oral steroids improve long-term visual outcome.

The statistics, in plain English

A hazard ratio of 2.19 means inflammation resolved at about twice the rate on any given day with added prednisone. The study was not randomised, and clinicians probably gave oral steroids to worse cases, which would bias against the oral group — so the benefit is unlikely to be overstated on that count, but other differences could still play a part.

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