Intravitreal Dexamethasone Implant in the Treatment of Non-infectious Uveitis

Abstract

Objectives:To evaluate the long-term results of intravitreal dexamethasone implant (DEX) for noninfectious uveitis.Materials and Methods:The study included 62 eyes of 44 patients treated with DEX implant due to noninfectious uveitis and followed up for at least a year. Best-corrected visual acuity (BCVA), central foveal thickness, intraocular pressure (IOP), vitreous haze score, indications, immunomodulatory therapy and steroid usage before/after injection, number of injections, and adverse events were analyzed retrospectively.Results:Average follow-up was 20 months (range 12-64 months). The female/male ratio was 29/15. Mean age was 50 years (range 22-75 years). The most frequent uveitis etiologies were idiopathic (25 patients, 40.3%) and Behçet’s uveitis. (17 patients, 27.4%) The signedmost common indication for DEX injection was cystoid macular edema together with resistant vitreous haze (26 eyes, 41.9%). Twenty-two eyes (30%) received more than one DEX injection. Mean BCVA was improved from 0.55 logMAR at baseline to 0.38, 0.32, and 0.35 after 1, 3, and 6 months, respectively (p<0.001 for each). Mean CFT was decreased from 386 μm at baseline to 288, 311, and 302 μm after 1, 3, and 6 months, respectively (p<0.001 for each). Mean IOP did not change significantly during follow-up. Five eyes (8%) received topical anti-glaucoma medication (IOP ≥25 mmHg). Eighteen (46%) of 39 phakic eyes underwent cataract surgery during follow-up. Similar efficacy of the DEX implant was observed in eyes that received multiple injections. Systemic immunomodulatory therapy did not change significantly during follow-up.Conclusion:Intravitreal DEX injection does not alter systemic immunomodulatory therapy, but may facilitate the management of noninfectious uveitis by suppressing local intraocular inflammation. Multiple injections yielded comparable visual and anatomical outcomes to single injections. Follow-up for ocular hypertension and cataract formation are important, especially in eyes receiving multiple injections.

Ocular adverse events associated with immune checkpoint inhibitors: a novel multidisciplinary management algorithm

“…His symptoms partially improved on restarting oral steroids (10 mg prednisolone daily), pointing to an inflammatory cause of his visual symptoms. On the basis of this evidence, he was offered short-acting and long-acting intravitreal steroid implants, 22 (dexamethasone 0.7 mg and fluocinolone acetonide, respectively, Figure 1c ) to avoid chronic side effects of long-term systemic steroids. At the time of data cut-off, the patient remained disease free, with relatively minor persistent visual impairment.…”

“… 7 As in our own series, most published series describe initial intervention with topical and/or oral corticosteroids. Although outcomes are generally good, with complete resolution of inflammation in most cases, some cases are recalcitrant, warranting alternative immunomodulatory agents, while peri-ocular or intravitreal steroids 22 have been employed as steroid-sparing strategies.…”

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

“…A significant increase in VA and decrease in CMT and vitreous haze (VH) were observed in patients with NIUs treated with Ozurdex and followed up for at least 1 year [46]. In this study multiple injections yielded comparable visual and anatomical outcomes to single injections, and mean IOP did not change significantly during follow-up [46].…”

“…A significant increase in VA and decrease in CMT and vitreous haze (VH) were observed in patients with NIUs treated with Ozurdex and followed up for at least 1 year [46]. In this study multiple injections yielded comparable visual and anatomical outcomes to single injections, and mean IOP did not change significantly during follow-up [46]. The efficacy and safety of repeated DEX implants in patients with NIUs were further confirmed by several studies, with a median duration of therapeutic effect of 6 months and a transient rise in mean IOP always well managed by topical medication [46][47][48][49].…”

<p>Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review</p>

“…More recently, it has also been approved for the treatment of diabetic macular edema (DME). Numerous studies examining various numbers of DEX treatments and lengths of treatment have demonstrated its effectiveness at treating RVO, 1-5 uveitis [6][7][8][9][10] and DME. [11][12][13][14][15][16] As patients receive multiple DEX implants over extended lengths of treatment the concern grows for more significant intraocular pressure (IOP) elevations and cataract progression, both well-documented complications.…”