Single Dexamethasone Intravitreal Implant in the Treatment of Noninfectious Uveitis

Abstract

In our patients with active noninfectious uveitis, injection of a first single dexamethasone implant was found to improve visual acuity and decrease macular thickness without significant increase of IOP, although the effect seems limited in time.

The double-edged sword of inflammation in inherited retinal degenerations: Clinical and preclinical evidence for mechanistically and prognostically impactful but treatable complications

“…However, there can be rebound effects from prolonged treatment or following discontinuation ( Apushkin et al, 2007 ), since CAIs do not address any underlying inflammatory component, as noted in uveitis patients with CME ( Schilling et al, 2005 ). Therefore, in the uveitis subspecialty world, in which the inflammatory etiology of CME is well established and accepted, CME is far more commonly treated with topical steroids, non-steroidal anti-inflammatory drugs (NSAIDs), in conjunction with oral steroids, various types of steroid-sparing immuno-modulating treatment (IMT) regimens such as mycophenolate mofetil (MMF), methotrexate (MTX), azathioprine (AZT), and more recently a variety of biologic agents such as adalimumab, with or without subtenon, intravitreal and—more recently also—suprachoroidal steroid injections or injectable/implantable steroid slow-releasing devices ( Steinmetz et al, 1991 ; Tanner et al, 1998 ; Tranos et al, 2004 ; Androudi et al, 2005 ; Jain et al, 2005 ; Perry and Donnenfeld, 2006 ; Hariprasad and Callanan, 2008 ; Hogewind et al, 2008 ; Jones and Francis, 2009 ; Slabaugh et al, 2012 ; Wu et al, 2012 ; Bourgault et al, 2013 ; Koop et al, 2013 ; Rossetto et al, 2015 ; Sen et al, 2015 ; Grixti et al, 2016 ; Asproudis et al, 2017 ; Feiler et al, 2017 ; Frere et al, 2017 ; Juthani et al, 2017 ; Khurana et al, 2017 ; Pichi et al, 2017 ; Doycheva et al, 2018 ; Petrushkin et al, 2018 ; Schallhorn et al, 2018 ; Hasanreisoglu et al, 2019 ; Ansari et al, 2021 ; Saade et al, 2021 ; Wong et al, 2021 ; Chronopoulos et al, 2022 ; Studsgaard et al, 2022 ; Miguel-Escuder et al, 2023 ). These remedies have been used successfully to manage CME in RP patients who are refractory or incompletely responsive to CAIs ( Forte et al, 1994 ; Heckenlively et al, 1999 ; Saraiva et al, 2003 ; Kim, 2006 ; Scorolli et al, 2007 ; Park et al, 2013 ; Ahn et al, 2014 ; Patil and Lotery, 2014 ; Lemos Reis et al, 2015 ; Schaal et al, 2016 ; ...…”

Microvascular Changes In The Recurrent Cystoid Macular Edema Secondary to Posterior Noninfectious Uveitis on Optical Coherence Tomography Angiography

“…[16][17][18][19] Since the trial by Lowder et al in 2011, 20 the safety, tolerability, and e cacy of the DEX-implant in noninfectious uveitic macular edema (ME) was reported. [21][22][23][24] However, the treatment was not always lasting in the long-term, and some cases of recurrent CME associated with uveitis were recorded. 25 The pathogenesis of the recurrence of CME in uveitis may be anatomical and functional changes of the retinal vessels.…”

Intravitreal therapeutic agents in noninfectious uveitic macular edema

“…[ 3 ] Furthermore, periocular injections are associated with their own side effects – ptosis, extraocular muscle injury, globe penetration, subdermal fat atrophy, or skin depigmentation. [ 1 15 ] Systemic use of corticosteroids and immunosuppressive agents may not achieve effective concentration in vitreous cavity due to physiological properties of the blood–retinal barrier, leading to the requirement of higher doses of these agents which again in turn are associated with potential side effects. [ 2 14 ] Intravitreal route allows relatively lower doses of the drug to be administered while achieving high concentration in the target areas, avoiding the risk of side effects associated with systemic use of the drug[ 13 ] Local side effects such as cataract, glaucoma, sterile and infectious endophthalmitis, hypotony, intravitreal hemorrhage, and retinal detachment have been reported with the use of intravitreal injection although incidence of such complications is relatively low.…”

“…Intravitreal drugs are now considered as a safe and effective treatment option for the management of noninfectious uveitis, especially in patients with unilateral disease without any systemic component. [ 15 16 ] This article reviews the various intravitreal drugs used for the treatment of ME secondary to noninfectious uveitis.…”