Dexamethasone intravitreal implant (Allergan) for the treatment of noninfectious uveitis

Abstract

Introduction: Intravitreal corticosteroid implants have dramatically changed the treatment of uveitis. This review focuses on available data on the safety and efficacy of the dexamethasone implant in context of other local therapies – the fluocinolone acetonide (FA) implant and intravitreal triamcinolone acetonide injections.

Areas covered: The FDA approved Retisert® (intravitreal FA sustained release implant) in 2005 and Ozurdex® (biodegradable dexamethasone implant) in 2010, both for treatment of posterior segment noninfectious uveitis. A PubMed literature search was carried out using keywords: intravitreal implant, fluocinolone, dexamethasone implant, triamcinolone, intravitreal drug delivery and uveitis.

Expert opinion: The dexamethasone implant reduces vitreous haze and cystoid macular edema (CME) and results in improved vision in patients with uveitis. While the reduction in CME does not persist for 26 weeks, the visual acuity increase does. One-fourth of patients treated with a single injection as part of the HURON trial required ocular hypotensives over a 6-month period despite stringent intraocular pressure inclusion criteria. This implant is valuable for short-term local therapy and as an adjunctive for chronic uveitis. Its duration of action does not support a single injection as long-term monotherapy for chronic uveitis and available data do not yet support the role of repeated injections for treatment of chronic uveitis.

Keywords::

• corticosteroids
• dexamethasone
• fluocinolone acetonide
• intravitreal implants
• macular edema
• ozurdex
• steroid therapy
• triamcinolone acetonide
• uveitis