Review of the latest local treatments for uveitis

Abstract

There have been many recent advances in local therapeutic options for uveitis, both corticosteroid and non-corticosteroid. Long- and short-acting steroid implants are now available, with new ones being developed. There are also new locations for drug delivery (suprachoroidal space) and new non-corticosteroid options. This paper reviews the data on the currently available local treatment options, as well as those currently under investigation. The choice of local therapy depends on whether or not there is systemic inflammatory disease also requiring treatment, if the disease is unilateral or bilateral, expected disease duration, patient preference and co-existing ocular and systemic comorbidities. For chronic disease without systemic manifestations, long-term steroid releasing implants are a good option, whereas for breakthrough inflammation and cystoid macular edema, short-term intravitreal therapy, initially with corticosteroids then with alternative agents is considered.

Keywords::

• intravitreal
• kenalog
• methotrexate
• panuveitis
• sirolimus
• steroid
• suprachoroidal
• triamcinolone
• Triesence
• uveitis

Financial & competing interests disclosure

DA Goldstein is a consultant for Clearside Biomedical Inc, has previously been a consultant for Bausch and Lomb and has received research support and lecture fees from both. Lecture fees have also been received from Allergan. 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.

Key issues

• Uveitis: disease burden, causes of visual morbidity and cumulative damage.

• Local therapies: corticosteroids, methotrexate, anti-VEGFs, sirolimus.

• Intravitreal corticosteroids: non-biodegradable sutured implant (fluocinolone acetonide), biodegradable injectable implant (dexamethasone).

• Investigational therapies: injectable non-biodegradable implant (fluocinolone acetonide), suprachoroidal space injection (triamcinolone acetonide) and subconjunctival/intravitreal injection of antibiotic/immunomodulator (sirolimus).

• Non-approved local therapies: intravitreal methotrexate and intravitreal anti-VEGF (bevacizumab and ranibizumab).

• Local versus systemic therapy: when to choose?