Dexamethasone intravitreal implant for the treatment of noninfectious uveitis

Abstract

Uveitis can be a sight-threatening eye disease with significant morbidity. Corticosteroids remain the mainstay of treatment of uveitis and provide an effective treatment against ocular inflammation. However, the various modes available for corticosteroid drug delivery can carry significant ocular and systemic side effects which can limit their use in the treatment of uveitis. In an effort to avoid the damage to ocular structures that can ensue with recurrent episodes of ocular inflammation, the side effects associated with systemic steroids, and the need for repeated administration of both topical and locally injected corticosteroids, sustained-release intraocular corticosteroid implants have been developed. The dexamethasone (DEX) drug delivery system (Ozurdex®; Allergan Inc, Irvine, CA), is a biodegradable intravitreal implant. This implant has been shown to be effective in the treatment of macular edema and noninfectious posterior uveitis and has been approved by the FDA for these entities. This review will highlight the current methods available for corticosteroid delivery to the eye with a particular emphasis on the DEX intravitreal implant and the evidence currently available for its use in noninfectious uveitis.

Modern Therapeutic Approaches for Noninfectious Ocular Diseases Involving Inflammation

“…[57] A non-biodegradable implant containing fluocinolone acetonide (Retisert, Bausch & Lomb, Rochester, NY, United States) was the first to be approved by the FDA for the treatment of severe, non-infectious uveitis. [58] Vitrasert® (Bausch & Lomb, Rochester, NY, United States) is another example of a non-biodegradable implant. Specifically, Vitrasert® is the first implantable ganciclovir delivery system approved for the treatment of cytomegalovirus retinitis.…”

“…[119] A few inflammatory conditions treated with the administration of corticosteroids include: asthma, chronic obstructive pulmonary disease (COPD), uveitis, and age-related macular degeneration. [58,119,120] Corticosteroids have multiple methods of action to abate inflammation. [119] Classically, one prominent method of action is through the glucocorticoid receptor mediated pathways, which act to inhibit the synthesis of multiple inflammatory proteins thereby suppressing pro-inflammatory genes and lymphocyte activation.…”

Pharmacotherapy for uveitis: current management and emerging therapy

“… 198 Retisert (Bausch & Lomb Incorporated, Bridgewater, NJ, USA) contains 0.59 mg FA, which is surgically placed into the vitreous cavity, where it persists for 30 months. 199 It was approved for use in noninfectious uveitis by the US Food and Drug Administration (FDA) in 2005, and several large-scale studies have documented its efficacy. 200 – 202 It is, however, associated with significant side effects.…”

Ocular pulse amplitude and retinal vessel caliber changes after intravitreal dexamethasone implant

“…The dexamethasone drug delivery system (Ozurdex ® , Allergan, Irvine, CA, USA) is a biodegradable, intravitreal implant that provides a sustained-release delivery of 0.7 mg of preservative-free dexamethasone to the vitreous. 1 …”