The intravitreal use of corticosteroids

Abstract

The use of intravitreal steroids was first explored some 35 years ago, and the enthusiasm for its use has waxed and waned over that time. This article reviews the pharmacology of different corticosteroid agents and drug delivery systems. The literature on the utility of steroids is reviewed and categorized by retinal vascular disease entity, that is, diabetic macular edema and retinal venous occlusive disease, age-related macular degeneration, posterior uveitis and pseudophakic macular edema. The significant toxicity and complications that occur with intravitreal and implantable steroids, which significantly limits their usefulness, is reviewed and discussed. It seems likely that the enthusiasm for intraocular steroids as a primary treatment for retinal vascular diseases such as diabetic macular edema and retinal venous occlusive disease will continue to wane further and be supplanted by anti-VEGF therapies. The potent and largely unmatched anti-inflammatory properties of steroids will continue to make this a treatment of choice for posterior uveitis. Implantable or injectable sustained release devices will be particularly useful in these difficult patients where the local toxicity of intraocular steroids compares favorably against the more significant systemic toxicity of systemic immunosuppressive and immunomodulatory agents.

Keywords::

• cystoid macular edema
• diabetic macular edema
• intravitreal
• intravitreal steroids
• macular degeneration
• retinal vein occlusion
• triamcinolone
• uveitis

Financial & competing interests disclosure

Peter Kertes has received research support from Alimera Sciences and Bausch and Lomb, and honoraria from Allergan and Bausch and Lomb. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.