Intravitreal therapeutic agents in noninfectious uveitic macular edema

Abstract

The management of uveitis is challenging for most treating ophthalmologists. The treatment of uveitis often requires the use of high dose of systemic corticosteroid and immunosuppressive agents, which are almost always associated with potential side effects. Intravitreal medications have become a popular mode of drug administration in uveitis patients as they provide high volume of drug to the target tissues, eliminating the risk of systemic toxicity. There has been tremendous development in the intravitreal therapeutics over the last few years. With the advent of sustained-release technique, increasing patient compliance, biodegradable nature of the implant, and introduction of newer agents with better safety profile, the intravitreal medications have become more popular in recent years. This review presents evidence in the scientific literature supporting the use of intravitreal medications for the management of uveitis and its complications.

Treatment of non-infectious retinal vasculitis

“…Because the duration of IVTA is short, intravitreal dexamethasone implant is thought by many to produce a more sustained effect than IVTA but was comparable with IVTA at 8 weeks in decreasing the central subfield thickness in uveitic macular edema. 25 – 27 There are case reports that suggest that the addition of intravitreal dexamethasone implant improved visual outcomes, macular edema, and resolution of RV, in entities, such as BD-associated uveitis and RV, and in IRVAN. 28 , 29 There were some elevations in intraocular pressure noted in some of these reports, following the use of the steroid implant.…”

Plasmapheresis in Ophthalmology

“…Most often they use long-term steroids and cyclosporine therapy, having such side effects as cataracts, osteoporosis, diabetes and hypertension [101,102]. Conventional immunosuppressive therapy and cytotoxic drugs do not prevent recurrent exacerbations and complex treatment with plasmapheresis provides more stable results [69,103]. Plasmapheresis is used in combination with blood cells ozonation [104].…”

Intravitreal Fluocinolone Acetonide (Retisert) Implantation Using a Keratome Blade

“…Conventional techniques use a 20-gauge microvitreoretinal (MVR) blade to create the sclerotomy wound. 2 We demonstrate use of a 2.4-mm keratome blade to create the sclerotomy wound.…”