Treatment of refractory uveitic macular edema: results of a first and second implant of long-acting intravitreal dexamethasone

Abstract

Purpose

The purpose of this study was to report the functional and anatomical outcomes of a prospective study resulting from repeated dexamethasone intravitreal implants in patients with uveitic refractory macular edema.

Methods

Twelve eyes of 9 patients with intermediate and posterior noninfectious inflammatory uveitis complicated with refractory macular edema were regularly reviewed after a dexamethasone intravitreal implant. Patients were examined at baseline, 30, 90, 135, and 180 days with best-corrected visual acuity (BCVA), complete slit-lamp examination, intraocular pressure (IOP), optical coherence tomography, and fluorescein angiography. After 6 months of follow-up, eyes were reassessed to receive a second implant.

Results

BCVA significantly improved when comparing the baseline values after the first and second implant (16.2 and 25.8 letters, respectively, 9.6 letters improvements, p<0.05). BCVA was better after the second implant compared to the first one throughout the follow-up, but without statistical significance. Mean central macular thickness (CMT) was 446.3±129.9 μm at baseline and was significantly reduced until day 135 (p<0.05). CMT reductions after the second injection showed a similar pattern, though differences were not statistically significant. Cataract progression was observed in 4 of 8 phakic eyes (50%) after the first implant, and in 2 of 3 phakic eyes following the second implant, with 1 eye requiring cataract surgery. One eye developed an IOP >30 mmHg 30 days after the second implant, treated topically.

Conclusion

Repeated dexamethasone intravitreal implants in uveitic patients with refractory macular edema can be used effectively in a clinical setting with an acceptable safety profile.

Keywords:

• uveitis
• macular edema
• dexamethasone
• intavitreal implant

Supplementary materials

Figure S1 Anterior chamber migration of the long-acting intravitreal dexamethasone implant with corneal edema in an aphakic patient.

Notes: Postural maneuvres with previous pupil dilation allowed correct repositioning of the implant with full resolution of the corneal edema and restoration of the VA before the complication. (A) Migration of the dexamethasone intravitreal implant into the anterior chamber. (B) Resolution of corneal edema after repositioning of the device into the vitreous chamber.

Abbreviation: VA, visual acuity.

Figure S2 OCT image of an epiretinal membrane 30 days after intravitreal dexamethasone injection.

Abbreviation: OCT, optical coherence tomography.

Figure S3 OCT image of an epiretinal membrane 90 days after intravitreal dexamethasone injection.

Abbreviation: OCT, optical coherence tomography.

Figure S4 OCT image of an epiretinal membrane 180 days after intravitreal dexamethasone injection.

Abbreviation: OCT, optical coherence tomography.

Table S1 Eyes receiving the first and second dexamethasone intravitreal implant, and the mean interval between injections

Table S2 Changes in BCVA and CMT following one dexamethasone intravitreal implant in 9 eyes affected by noninfectious inflammatory uveitis, considering only the worst eye for patients receiving treatment in both eyes

Disclosure

The authors report no conflicts of interest in this work.