Corticosteroid implants for chronic non-infectious uveitis

Reddy, Amit K.; Liu, Su-Hsun; Brady, Christopher J.; Sieving, Pamela C.; Palestine, Alan G.

doi:10.1002/14651858.cd010469.pub3

Cited by 5 publications

(5 citation statements)

References 75 publications

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“…However, periocular injections may exhibit a shorter duration of action and a heightened risk of periocular side effects like ptosis or subconjunctival haemorrhage [ 25 ]. Intravitreal injections have a more direct impact on the retina and vitreous and might provide longer-lasting effects compared to periocular injections [ 26 ]. According to the result from POINT trial, both intravitreal triamcinolone acetonide and the dexamethasone implant were superior to periocular triamcinolone acetonide for the treatment of uveitic macular oedema with modestly greater rates of mild intraocular pressure (IOP) elevation.…”

Section: Resultsmentioning

confidence: 99%

“…Implants like fluocinolone acetonide (Retisert) or dexamethasone (Ozurdex) have demonstrated effectiveness in managing inflammation and preserving visual acuity in uveitis patients [ 15 ]. Retisert provides longer effect but higher CS related complications, such as cataract and elevated IOP [ 26 ]. A lower dose long-acting injectable fluocinolone acetonide implants (Iluvien, Yutiq) were developed and reported to have an acceptable side-effect profile [ 30 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

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Use of corticosteroids in non-infectious uveitis – expert consensus in Taiwan

Chang,

Kao,

Chen

et al. 2024

Annals of Medicine

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Purpose To offer consensus on the utilization of corticosteroids (CS) for treating non-infectious uveitis in the context of clinical practice in Taiwan. This entails examining the different administration methods, their advantages and disadvantages, and considering alternative treatments according to the prevailing evidence and health policies. Methods Ten ophthalmologists and one rheumatologist convened on December 11, 2022, to review and discuss literature on the topic. The databases explored were the Central Cochrane library, EMBASE, Medline, PUBMED, and Web of Science using relevant keywords. The search spanned from January 1996 to June 2023. After the initial results of the literature review were presented, open voting determined the final statements, with a statement being accepted if it secured more than 70% agreement. This consensus was then presented at significant meetings for further discussions before the final version was established. Results A flow chart and nine statements emerged from the deliberations. They address the importance of CS in uveitis management, guidelines for using topical CS, indications for both periocular or intravitreal and systemic therapies, and tapering and discontinuation methods for both topical and systemic CS. Conclusion While CS are a cornerstone for non-infectious uveitis treatment, their administration requires careful consideration, depending on the clinical situation and the specific type of uveitis. The consensus generated from this article provides a guideline for practitioners in Taiwan, taking into account local health policies and the latest research on the subject. It emphasizes the significance of strategic tapering, the potential for alternative therapies, and the importance of patient-centric care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Use of corticosteroids in non-infectious uveitis – expert consensus in Taiwan

Chang,

Kao,

Chen

et al. 2024

Annals of Medicine

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“…Conversely, intermediate, posterior and panuveitis require systemic steroid treatment from the beginning due to the low penetrance of topical agents in the posterior eye sector [100]. Intraocular implants with dexamethasone or fluocinolone could be an effective alternative [101,102], minimizing the dose or frequency of administration, but at the same time exacerbating ocular side effects such as cataract formation, ocular hypertension, and glaucoma or chorioretinopathy [103].…”

Section: Treatmentmentioning

confidence: 99%

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Migliorisi,

Vella,

Dal Buono

et al. 2024

Cells

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Background and aims: Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn’s disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. Methods: PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. Results: The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs’ pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs.

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“…Intravitreal corticosteroid implants may increase the risk of elevated intraocular pressure and cataract formation [67].…”

Section: Safety: Intraocular Pressure/cataractmentioning

confidence: 99%

“…In addition to raised intraocular pressure, development of cataract is one of the major concerns when using intravitreal corticosteroids [10,15,[67][68][69]. According to the results of the clinical trials, cataract surgery was more frequently required in the FAc implant treated group than in the sham-treated group (73.8% vs. 23.8% of eyes, respectively) [15,68].…”

Section: Safety: Intraocular Pressure/cataractmentioning

confidence: 99%

Fluocinolone acetonide 0.2 µg/day intravitreal implant in non-infectious uveitis affecting the posterior segment: EU expert user panel consensus-based clinical recommendations

Pleyer,

Pavesio,

Miserocchi

et al. 2024

J Ophthal Inflamm Infect

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Background Non-infectious uveitis affecting the posterior segment of the eye (NIU-PS) is an inflammatory disease, which can significantly impair visual acuity if not adequately treated. Fluocinolone-acetonide sustained-release-0.2 µg/day intravitreal (FAc) implants are indicated for prevention of relapse in recurrent NIU-PS. The aim here was to provide treating clinicians with some consensus-based-recommendations for the clinical management of patients with NIU-PS with 0.2 µg/day FAc implants. Methods A European-clinical-expert-group agreed to develop a consensus report on different issues related to the use of FAc implants in patients with NIU-PS. Results The Clinical-expert-panel provided specific recommendations focusing on clinical presentation (unilateral/bilateral) of the NIU-PS; systemic involvement of NIU-PS and the lens status. Treatment algorithms were developed; one that refers to the management of patients with NIU-PS in clinical practice and another that establishes the best clinical scenarios for the use of FAc implants, both as monotherapy and as adjuvant therapy. Additionally, the Clinical-expert-panel has provided recommendations about the use of the FAc implants in a clinical-setting. The Clinical-expert-panel also considered the safety profile of FAc implants and their possible implications in the daily practice. Conclusions As more clinical experience has been gained using FAc implants, it was necessary to update the clinical recommendations that guide patient management in the clinic. The current consensus document addresses relevant issues related to the use of FAc implants on different types of patients with various etiologies of NIU-PS, and was conducted to standardize approaches to help specialists obtain better clinical outcomes.

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Corticosteroid implants for chronic non-infectious uveitis

Cited by 5 publications

References 75 publications

Use of corticosteroids in non-infectious uveitis – expert consensus in Taiwan

Use of corticosteroids in non-infectious uveitis – expert consensus in Taiwan

Ophthalmological Manifestations in Inflammatory Bowel Diseases: Keep an Eye on It

Fluocinolone acetonide 0.2 µg/day intravitreal implant in non-infectious uveitis affecting the posterior segment: EU expert user panel consensus-based clinical recommendations

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