Dexamethasone Intravitreal Implant: An Effective Adjunctive Treatment for Recalcitrant Noninfectious Uveitis

Abstract

Purpose: To describe our experience in treating recalcitrant and severe cases of noninfectious posterior uveitis with the 0.7-mg dexamethasone intravitreal implant as adjunctive anti-inflammatory treatment. Procedures: Retrospective study. Twelve patients (8 females; 4 males; 14 affected eyes, 15 implants) with severe recalcitrant uveitis were treated. Patients had an inadequate control of uveitis despite different immunosuppressants and periocular corticosteroid therapy. Primary outcome measures evaluated were: decrease in uveitis activity, improvement in visual acuity, reduction of macular thickness, and occurrence of adverse events. Results: Uveitis activity decreased in all patients after the implant. The mean follow-up time from injection was 9 months. Best-corrected visual acuity improved from 20/80 to 20/40 at the end of follow-up. The mean retinal thickness improved from 496 to 226 µm. Adverse events encountered were: 3 eyes with intraocular pressure elevation, 1 vitreous hemorrhage and 1 subconjunctival hemorrhage. Three patients reduced the daily systemic corticosteroid dosage after treatment. Conclusions: The 0.7-mgdexamethasone intravitreal implant appears to be a novel and promising adjunctive treatment for patients with severe posterior noninfectious uveitis recalcitrant to different immunosuppressive agents.

Intravitreal Dexamethasone Implant in Patients with Persistent Macular Edema of Variable Etiologies

“…The DME and vein occlusion groups showed slower CME resolution (8 weeks in both). A fast reduction of CMT in uveitic CME, occurring 2 weeks after DEX-DDS injection, was also demonstrated by Miserocchi et al [29]. However, this study did not present data regarding CME resolution, only data regarding CMT reduction.…”

“…A study evaluating DEX-DDS treatment in 10 eyes with recalcitrant uveitic CME showed good response to DEX-DDS with improvement in retinal thickness and visual acuity. However, the duration of CME prior to treatment was not reported and the authors do not give any data on edema relapse in this study [29]. Another study evaluated DEX-DDS effect in vitrectomized eyes with persistent uveitic CME.…”

“…There is little evidence in the published literature of the effect of DEX-DDS in the treatment of edema persisting following other treatments [28,29,30,31,32,33]. The purpose of our study was to examine the effect of DEX-DDS in patients with severely recalcitrant CME that had a poor or short-term response to other treatment modalities.…”

A systematic review and economic evaluation of adalimumab and dexamethasone for treating non-infectious intermediate uveitis, posterior uveitis or panuveitis in adults

“…18,50,51,[79][80][81][82][83][84][85][86] This is based on data from the company submission for DEX; 43 the original study publications have not been examined because of time constraints. These data are included here as they provide some data on repeat implants, implants in both eyes and corticosteroid reduction, which were not assessed in the HURON trial.…”

“…81 Implants in both eyes were assessed in one study, with 3 out of 11 patients (27%) receiving implants in both eyes having a response (reduced central retinal thickness and improved BCVA) in the second eye. 18 In terms of reduction in other therapies following a single implant, one study reported that 21 out of 27 patients (78%) reduced or stopped systemic or local treatment, 18 whereas in another study 3 out of 12 patients (25%) reduced their corticosteroid dose 79 and in another study systemic corticosteroids were reduced or discontinued in 14 out of 32 patients (44%) and discontinued in 8 out of 32 patients (25%) at 6 months. 82 Among studies using a mix of single or multiple implants, in one study systemic corticosteroids or immunosuppressants were reduced in 62% of patients and steroids were discontinued in 36% of patients at 12 months 50 and in another study systemic corticosteroids were reduced or discontinued in 78% of patients and discontinued in 32% of patients at 12 months.…”