Intravitreal Dexamethasone Implants for Refractory Macular Edema in Eyes with Noninfectious Uveitis

Abstract

Macular edema (ME) is a common cause of visual loss among eyes with uveitis, and its management can be challenging. Steroids are an effective treatment for ME, and intravitreal dexamethasone (DEX) implants provide sustained steroid release. The purpose of this study is to evaluate intravitreal DEX implant on refractory ME in eyes with noninfectious uveitis. A retrospective study including 52 eyes of 37 patients with refractory uveitic ME was conducted from January 2011 through August 2017 at Linkou Chang Gung Memorial Hospital in Taiwan. Patients’ demographic characteristics were collected. In addition, clinical information, including corrected visual acuity (VA), intraocular pressure (IOP), and central retinal thickness (CRT) on optical coherence tomography, was recorded and analyzed. During the study period, affected eyes received a total of 110 intravitreal DEX implants (range, one to six in each eye). After the first DEX implant injection in all eyes, VA significantly improved at one and two months. CRT significantly decreased one month after a single DEX implant, and the effect lasted for six months and waned over time. Patients receiving multiple DEX implants still showed significant decreases in CRT one month after the first implant. Increases in IOP were noted one month after the DEX implant, but the IOP could be medically controlled. Intravitreal DEX implants can effectively treat refractory uveitic ME, improving both VA and CRT with an acceptable safety profile. Further studies are necessary to evaluate the effect of multiple implants and long-term outcomes.

Clinical and imaging biomarkers of response to intravitreal dexamethasone implant in eyes with non-infectious uveitic macular oedema

“…4 Subsequent real-world studies showed that functional and anatomic responses to DEX are not always favourable, 5 and MO may persist in up to 50% of cases. [6][7][8][9][10] There is a knowledge gap regarding the clinical and morphologic factors predicting the response to intravitreal DEX in NIU MO patients.…”

“…4 Subsequent real-world studies showed that functional and anatomic responses to DEX are not always favourable, 5 and MO may persist in up to 50% of cases. [6][7][8][9][10] There is a knowledge gap regarding the clinical and morphologic factors predicting the response to intravitreal DEX in NIU MO patients.Optical coherence tomography (OCT) allows a repeatable evaluation of central macular thickness (CRT) and retinal layers' integrity. 11 Previous studies showed only a moderate correlation between visual acuity (VA) and CRT; 12 thus, alternative biomarkers explaining VA variability in NIU MO patients must be identi ed.…”

Real-world effectiveness of intravitreal dexamethasone implants - Comparison between eyes eligible and ineligible for clinical trials and their associated outcomes

“…We performed a mixed model analysis based on the intent-to-treat approach to evaluate the time-varying 3-month, 6-month, and 12-month changes in LogMAR VA, CRT, and IOP, since these outcomes were repeatedly measured during the follow-up period [ 29 ]. The mixed model analysis factored in the assessment time points, the different groups, and the interaction between these two parameters as fixed effects and among individual patients as random effects.…”

Efficacity and Safety of the Fluocinolone Acetonide Implant in Uveitic Macular Edema: A Real-Life Study from the French Uveitis Network

“…However, the outcomes of DEXi are not always favorable with up to 50% of UME patients being unresponsive or partly responsive. In addition, the durability of DEXi does not exceed four to six months [ 9 , 11 , 12 , 13 , 14 , 15 ], implying the recourse to iterative invasive intravitreal procedures. In this vein, sustained release implants offer an interesting alternative, allowing a longer-term quiescence.…”