A 28-year-old male with known ankylosing spondylitis (HLA-B27 positive) presents with sudden onset right eye redness, pain, and photophobia for 3 days. Slit-lamp shows 3+ cells, 2+ flare, and a fibrin exudate in the pupillary area. Posterior segment is clear. He has had 3 similar episodes in the last 2 years, always in the same eye. What is the MOST appropriate chronic maintenance therapy to prevent recurrences?
- A Anti-TNF alpha therapy (adalimumab or infliximab) ✓
- B Methotrexate 15 mg weekly as a steroid-sparing agent
- C Topical prednisolone drops long-term as prophylaxis
- D Slow-release fluocinolone acetonide intravitreal implant
Explanation
HLA-B27 associated acute anterior uveitis (AAU), particularly recurrent, alternating unilateral episodes linked to ankylosing spondylitis (the most common associated systemic disease), is driven by TNF-alpha mediated inflammation. Anti-TNF biologics (adalimumab approved by FDA/EMA for non-infectious intermediate, posterior, and panuveitis; infliximab off-label) significantly reduce recurrence rates in HLA-B27 AAU, especially when linked to ankylosing spondylitis managed systemically. Methotrexate is used more for intermediate/posterior uveitis; intravitreal implants are for posterior segment disease.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.