Dexamethasone Inserts in Noninfectious Uveitis

Pohlmann, Dominika; Brocke, Gerrit Alexander vom; Winterhalter, Sibylle; Steurer, T; Thees, S; Pleyer, Uwe

doi:10.1016/j.ophtha.2017.12.038

Cited by 45 publications

(27 citation statements)

References 37 publications

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“…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].…”

Section: Evidence Of the Efficacy Of Dex In Posterior Non-infectious supporting

confidence: 67%

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

et al. 2020

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Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.

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Section: Evidence Of the Efficacy Of Dex In Posterior Non-infectious supporting

confidence: 67%

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

et al. 2020

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“…A further prospective, interventional study confirmed the effectiveness of dexamethasone implants, either alone or in combination with systemic therapies, by improving bestcorrected visual acuity, central retinal thickness, and vitreous haze, especially in patients with idiopathic and sarcoid uveitis. 113 Systemic CS should be used similarly as in noninfectious uveitis (►Fig. 6).…”

Section: Corticosteroidsmentioning

confidence: 99%

Ocular Sarcoidosis

Sève

Jamilloux

Tilikete

et al. 2020

Semin Respir Crit Care Med

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Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Wallsh¹,

Luths²,

Kil³

et al. 2020

OPTH

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Purpose: To evaluate the initial ten years of results from the intravitreal dexamethasone implant (DEX) in patients treated for retinal vein occlusion (RVO), diabetic macular edema (DME) or uveitis. Methods: Retrospective chart review of patients receiving DEX since its FDA approval. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure and cataract status were collected. Baseline data were collected from the initial DEX and post-treatment data at the visit at least four weeks after the last DEX. Results: In total, 315 eyes received 1216 DEX over 63.9±4.6 weeks. In the branch RVO (n=90), central RVO (n=59) and DME (n=62) cohorts, BCVA improved significantly (p<0.05). The uveitis (n=154) cohort did not have a significant change in BCVA, 0.62 ±0.04 to 0.61±0.04 logMAR (p=0.34). Younger patients, vitrectomized eyes, and eyes without a history of glaucoma were associated with significantly better BCVA outcomes in the uveitis cohort (p<0.05). Overall, CMT decreased significantly from 376.6±6.8 to 322.7±5.0 µm (p<0.05). Intraocular pressure increased significantly (p<0.001) and the percentage of patients requiring anti-glaucoma medications increased from 33.0% to 67.6%. Of phakic eyes, 58.8% (n=63) had cataract progression or underwent surgery with those who underwent surgery experiencing a significant improvement in BCVA (p<0.05). Conclusion: Repeated DEX over extended follow-up offers significant anatomic benefits to all cohorts. Visual benefits are only seen in RVO, DME and select uveitis demographics.

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Dexamethasone Inserts in Noninfectious Uveitis

Cited by 45 publications

References 37 publications

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

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

Ocular Sarcoidosis

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

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