The Sustained-Release Dexamethasone Implant: Expanding Indications in Vitreoretinal Disease

Abstract

Corticosteroids play an important role in the therapeutic approach to vitreoretinal disease. The Ozurdex implant (DEX Implant 0.7 mg, Ozurdex, Allergan Inc., Irvine, CA, USA) offers sustained release of dexamethasone in the vitreous cavity, and this novel drug delivery system has proven useful both in improving clinical outcomes and in reducing injection burden. While the Food and Drug Administration approves the use of the DEX implant in retinal vein occlusions and non-infectious posterior uveitis, its utilization continues to expand in its breadth of diversity across myriad vitreoretinal conditions. Additionally, modified injection techniques are evolving to improve the safety profile of the DEX implant in eyes that are often considered to have relative contraindications to its use, further extending its application. This review aims to evaluate the evidence supporting the expanding indications and injection techniques of the DEX sustained-release implant in vitreoretinal disease, and explores potential future indications for its use. Arenas for future research are also identified to further elucidate the precise role of the DEX implant in our current treatment model. Increased awareness of effective and safe uses of the DEX implant can refine our therapeutic approach to vitreoretinal disease and ultimately improve patient outcomes.

Effect of dexamethasone intravitreal implant (Ozurdex®) on corneal endothelium in retinal vein occlusion patients

“…Because of its anti-inflammatory and anti-angiogenic effect, DEX implant is indicated for various posterior segment diseases, like macular edema due to retinal vein occlusion (RVO), diabetic maculopathy and non-infectious posterior uveitis etc. [1–5]. …”

The nomadic Ozurdex®: Anterior migration of the dexamethasone implant and back!

“…[1] Although the advantages of this treatment are a longer duration of action and lower cost, it is not without complications, which include posterior subcapsular cataract formation, increased intraocular pressure (IOP), and glaucoma. [2] Migration of the implant into the anterior chamber is another known complication in aphakic eyes and pseudophakic eyes, with iris claw lenses and scleral-fixated intraocular lenses (SFIOLs). [345] Most of these cases have been managed surgically by removal or repositioning of the implant.…”

Towards an Optimized Use of Ocular Corticosteroids: EURETINA Award Lecture 2017

“…The clinical consequences of these observations might appear in the long term after years of retinal exposure to GCs. The controlled release of low doses of GCs from intraocular implants might reduce the risks of long-term retinal toxicity [31,32].…”