Intravitreal Steroids for the Treatment of Retinal Diseases

Abstract

Diabetic macular edema (DME), pseudophakic cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO), and uveitis are ocular conditions related to severe visual impairment worldwide. Corticosteroids have been widely used in the treatment of these retinal diseases, due to their well-known antiangiogenic, antiedematous, and anti-inflammatory properties. Intravitreal steroids have emerged as novel and essential tools in the ophthalmologist's armamentarium, allowing for maximization of drug efficacy and limited risk of systemic side effects. Recent advances in ocular drug delivery methods led to the development of intraocular implants, which help to provide prolonged treatment with controlled drug release. Moreover, they may add some potential advantages over traditional intraocular injections by delivering certain rates of drug directly to the site of action, amplifying the drug's half-life, contributing in the minimization of peak plasma levels of the drug, and avoiding the side effects associated with repeated intravitreal injections. The purpose of this review is to provide an update on the use of intravitreal steroids as a treatment option for a variety of retinal diseases and to review the current literature considering their properties, safety, and adverse events.

Early Effects of Dexamethasone Implant on Macular Morphology and Visual Function in Patients with Macular Edema Secondary to Retinal Vein Occlusion

“…The dexamethasone sustained-release implant Ozurdex was approved for the treatment of macular edema secondary to RVO after the pivotal GENEVA trial and it was soon included in the therapeutic armamentarium of the retina specialist [6,7,9,10]. Several studies reported its efficacy in decreasing CRT and improving visual function in RVO eyes [11,12,13,14,15].…”

“…The pathogenesis of macular edema secondary to RVO is complex. Multiple factors such as increased hydrostatic venous pressure, endothelial dysfunction, inflammation, and disturbed balance of angiogenic and inflammatory cytokines have been implicated [6,7,8,9]. …”

Emerging Trends in Ocular Drug Delivery: A Review on Recent Updates

“…Sustained release effect can be provided from 6-9 months following single injection into vitreous body. Cortiject is under the phase I/II development [32,33]. Carotuximab, (DE-122) an anti-endoglin antibody is being developed by Santen pharmaceuticals as an intravitreal injection for the treatment of age related macular degeneration [34].…”

Comments on 'Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants'

“…We felt it was important to highlight this finding following analysis of the long-term follow-up data on this subgroup of patients following cataract surgery, as the use of fluocinolone implant for diabetic macular oedema in UK is currently restricted by NICE guidance to only those patients who are pseudophakic. Although these guidelines have enabled patients with eyes that are pseudophakic and with persistent diabetic macular oedema following anti-vascular endothelial growth factor (VEGF) therapy to benefit from fluocinolone implant, 4 there is still an unmet need for those with diabetic macular oedema which is unresponsive to laser or anti-VEGF therapy in phakic eyes. We also agree that it would be interesting to investigate the effects of cataract surgery on steroid-induced ocular hypertension or glaucoma, but this was unrelated to the tight remit and scope of our study question and objective, and therefore, we did not include this analysis in our design.…”

“…Single intravitreal steroid injections have been reported to cause subcapsular cataract and multiple injections may affect all the lens layers. 4 Given the continuous low intraocular concentration of steroid with FAc implant, it would be interesting to evaluate the type of cataract seen in the CAI group.…”