Intraocular therapy in noninfectious uveitis

Abstract

Systemic corticosteroids and immunosuppressant agents are the mainstay of therapy for non-infectious uveitis (NIU). However, the risks associated with systemic administration and the need of delivering an effective and safe anti-inflammatory treatment targeted to the site of inflammation have prompt the use of local therapy in the management of NIU. This review will analyse the different local treatment options available, including corticosteroids, anti-vascular endothelial growth factor (VEGF), methotrexate and the recent biologics.

Treatment of Non-Infectious Posterior Uveitis with Dexamethasone Intravitreal Implants in a Real-World Setting

“…27 In addition to the patient discomfort caused, a slightly higher risk of AEs is associated with the use of these implants, such as surgery for increased IOP or cataract formation. 21 , 29 , 38 , 40 Hence, DEX biodegradable implants currently seem to offer the best benefits and safety to treat active, non-infectious posterior uveitis with local corticosteroids.…”

“…While anti-VEGF agents studied are safe and appear to offer benefits for this condition, their anti-inflammatory effects are limited and their short half-life requires frequent repeat injections. 15 , 40 , 41 Similarly, the short half-life of sirolimus limits its therapeutic use despite its good safety profile, and it is not clear if it produces real improvements in VA or CMT. It remains to be seen if the biodegradable intravitreal implants under development to administer these agents offer improvements.…”

“…It remains to be seen if the biodegradable intravitreal implants under development to administer these agents offer improvements. 15 , 40 , 41 There is also evidence that intravitreal methotrexate may be a good treatment for non-infectious posterior uveitis although this requires a longer lag period to produce a response, and it may be associated with other contraindications and safety issues. 15 , 40 , 41 There are little data regarding the intravitreal use of non-steroidal anti-inflammatory drugs (NSAIDs) although it may be an interesting future prospect.…”

“… 15 , 40 , 41 There is also evidence that intravitreal methotrexate may be a good treatment for non-infectious posterior uveitis although this requires a longer lag period to produce a response, and it may be associated with other contraindications and safety issues. 15 , 40 , 41 There are little data regarding the intravitreal use of non-steroidal anti-inflammatory drugs (NSAIDs) although it may be an interesting future prospect. 42 , 43 Advances in immunotherapy involving the use of different antibodies and adenoviral delivery systems may also improve the treatment of non-infectious posterior uveitis in the forthcoming years and as such, these should be borne in mind.…”

Commentary: Dexamethasone intravitreal implant therapy in Vogt–Koyanagi–Harada disease

“…Various steroid preparations and more recently even biologics have been used as periocular or intraocular injections in the treatment of uveitis. [ 1 ] Choice of the drug depends on the duration of action and the patient’s affordability.…”