Cover Image

Intravitreal Dexamethasone Implant in the Treatment of Non-Infectious Uveitic Macular Edema

Omer Karti, Ali Osman Saatci

Abstract


Macular Edema (ME) is a common complication, leading to severe vision loss in patients with Non-Infectious Uveitis (NIU). The treatment of uveitic ME is still very challenging for many ophthalmologists. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combatting uveitic ME. However, there is not enough evidence to support the efficacy of any of these agents. Intravitreal Dexamethasone Implant (IDI) (Ozurdex; Allergan Inc, Irvine, CA) is a widely administered corticosteroid for the long-term management of uveitic ME in certain cases. Ophthalmic implant is made up of a biodegradable copolymer that contains glycolic acid and lactic acid. Recent studies have demonstrated that dexamethasone implant effectively improves uveitis-related ME. The authors suggest that this effect could be sustained for at least six months with close monitoring and re-treatment, as needed. The current study reviewed major clinical studies about IDI in eyes with NIU and briefly overviewed their results.


References


de Smet MD, Taylor SR, Bodaghi B, Miserocchi E, Murray PI, Pleyer U, et al. Understanding uveitis: the impact of research on visual outcomes. Prog Retin Eye Res. 2011;30(6):452-70. doi: 10.1016/j.preteyeres.2011.06.005 pmid: 21807112

Bodaghi B, Cassoux N, Wechsler B, Hannouche D, Fardeau C, Papo T, et al. Chronic severe uveitis: etiology and visual outcome in 927 patients from a single center. Medicine (Baltimore). 2001;80(4):263-70. pmid: 11470987

Rothova A, Suttorp-van Schulten MS, Frits Treffers W, Kijlstra A. Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol. 1996;80(4):332-6. pmid: 8703885

Darrell RW, Wagener HP, Kurland LT. Epidemiology of uveitis. Incidence and prevalence in a small urban community. Arch Ophthalmol. 1962;68:502-14. pmid: 13883604

Suttorp-Schulten MS, Rothova A. The possible impact of uveitis in blindness: a literature survey. Br J Ophthalmol. 1996;80(9):844-8. pmid: 8962842

Goldhardt R, Rosen BS. Uveitic Macular Edema: Treatment Update. Curr Ophthalmol Rep. 2016;4(1):30-7. doi: 10.1007/s40135-016-0090-3 pmid: 27347446

de Smet MD, Julian K. The role of steroids in the management of uveitic macular edema. Eur J Ophthalmol. 2011;21 Suppl 6:S51-5. doi: 10.5301/EJO.2010.6056 pmid: 23264329

Freeman G, Matos K, Pavesio CE. Cystoid macular oedema in uveitis: an unsolved problem. Eye (Lond). 2001;15(Pt 1):12-7. doi: 10.1038/eye.2001.5 pmid: 11318279

Durrani OM, Meads CA, Murray PI. Uveitis: a potentially blinding disease. Ophthalmologica. 2004;218(4):223-36. doi: 10.1159/000078612 pmid: 15258410

Forrester JV. Uveitis: pathogenesis. Lancet. 1991;338(8781):1498-501. pmid: 1683927

Dick AD. Immune mechanisms of uveitis: insights into disease pathogenesis and treatment. Int Ophthalmol Clin. 2000;40(2):1-18. pmid: 10791254

Cordero Coma M, Sobrin L, Onal S, Christen W, Foster CS. Intravitreal bevacizumab for treatment of uveitic macular edema. Ophthalmology. 2007;114(8):1574-9 e1. doi: 10.1016/j.ophtha.2006.11.028 pmid: 17363060

de Smet MD, Okada AA. Cystoid macular edema in uveitis. Dev Ophthalmol. 2010;47:136-47. doi: 10.1159/000320077 pmid: 20703047

Ossewaarde-van Norel A, Rothova A. Clinical review: Update on treatment of inflammatory macular edema. Ocul Immunol Inflamm. 2011;19(1):75-83. doi: 10.3109/09273948.2010.509530 pmid: 21034302

Catier A, Tadayoni R, Paques M, Erginay A, Haouchine B, Gaudric A, et al. Characterization of macular edema from various etiologies by optical coherence tomography. Am J Ophthalmol. 2005;140(2):200-6. doi: 10.1016/j.ajo.2005.02.053 pmid: 15992752

Markomichelakis NN, Halkiadakis I, Pantelia E, Peponis V, Patelis A, Theodossiadis P, et al. Patterns of macular edema in patients with uveitis: qualitative and quantitative assessment using optical coherence tomography. Ophthalmology. 2004;111(5):946-53. doi: 10.1016/j.ophtha.2003.08.037 pmid: 15121373

Iannetti L, Accorinti M, Liverani M, Caggiano C, Abdulaziz R, Pivetti-Pezzi P. Optical coherence tomography for classification and clinical evaluation of macular edema in patients with uveitis. Ocul Immunol Inflamm. 2008;16(4):155-60. doi: 10.1080/09273940802187466 pmid: 18716950

Karim R, Sykakis E, Lightman S, Fraser-Bell S. Interventions for the treatment of uveitic macular edema: a systematic review and meta-analysis. Clin Ophthalmol. 2013;7:1109-44. doi: 10.2147/OPTH.S40268 pmid: 23807831

Venkatesh P, Kumar CS, Abbas Z, Garg S. Comparison of the efficacy and safety of different methods of posterior subtenon injection. Ocul Immunol Inflamm. 2008;16(5):217-23. doi: 10.1080/09273940802209153 pmid: 19065416

Winterhalter S, Behrens UD, Salchow D, Joussen AM, Pleyer U. Dexamethasone implants in paediatric patients with noninfectious intermediate or posterior uveitis: first prospective exploratory case series. BMC Ophthalmol. 2017;17(1):252. doi: 10.1186/s12886-017-0648-3 pmid: 29246154

Sella R, Oray M, Friling R, Umar L, Tugal-Tutkun I, Kramer M. Dexamethasone intravitreal implant (Ozurdex(R)) for pediatric uveitis. Graefes Arch Clin Exp Ophthalmol. 2015;253(10):1777-82. doi: 10.1007/s00417-015-3124-x pmid: 26228441

Sampat KM, Garg SJ. Complications of intravitreal injections. Curr Opin Ophthalmol. 2010;21(3):178-83. doi: 10.1097/ICU.0b013e328338679a pmid: 20375895

Fassbender Adeniran JM, Jusufbegovic D, Schaal S. Common and Rare Ocular Side-effects of the Dexamethasone Implant. Ocul Immunol Inflamm. 2017;25(6):834-40. doi: 10.1080/09273948.2016.1184284 pmid: 27379861

Lowder C, Belfort R, Jr., Lightman S, Foster CS, Robinson MR, Schiffman RM, et al. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011;129(5):545-53. doi: 10.1001/archophthalmol.2010.339 pmid: 21220619

Ratra D, Barh A, Banerjee M, Ratra V, Biswas J. Safety and Efficacy of Intravitreal Dexamethasone Implant for Refractory Uveitic Macular Edema in Adults and Children. Ocul Immunol Inflamm. 2018:1-7. doi: 10.1080/09273948.2018.1424342 pmid: 29394119

Haller JA, Dugel P, Weinberg DV, Chou C, Whitcup SM. Evaluation of the safety and performance of an applicator for a novel intravitreal dexamethasone drug delivery system for the treatment of macular edema. Retina. 2009;29(1):46-51. doi: 10.1097/IAE.0b013e318188c814 pmid: 18827732

Chang-Lin JE, Attar M, Acheampong AA, Robinson MR, Whitcup SM, Kuppermann BD, et al. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant. Invest Ophthalmol Vis Sci. 2011;52(1):80-6. doi: 10.1167/iovs.10-5285 pmid: 20702826

Kuppermann BD, Blumenkranz MS, Haller JA, Williams GA, Weinberg DV, Chou C, et al. Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol. 2007;125(3):309-17. doi: 10.1001/archopht.125.3.309 pmid: 17353400

London NJ, Chiang A, Haller JA. The dexamethasone drug delivery system: indications and evidence. Adv Ther. 2011;28(5):351-66. doi: 10.1007/s12325-011-0019-z pmid: 21494891

Nobre-Cardoso J, Champion E, Darugar A, Fel A, Lehoang P, Bodaghi B. Treatment of Non-infectious Uveitic Macular Edema with the Intravitreal Dexamethasone Implant. Ocul Immunol Inflamm. 2017;25(4):447-54. doi: 10.3109/09273948.2015.1132738 pmid: 27003221

Adan A, Pelegrin L, Rey A, Llorenc V, Mesquida M, Molins B, et al. Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients. Retina. 2013;33(7):1435-40. doi: 10.1097/IAE.0b013e31827e247b pmid: 23514796

Pohlmann D, Vom Brocke GA, Winterhalter S, Steurer T, Thees S, Pleyer U. Dexamethasone Inserts in Noninfectious Uveitis: A Single-Center Experience. Ophthalmology. 2018;125(7):1088-99. doi: 10.1016/j.ophtha.2017.12.038 pmid: 29459041

Yalcinbayir O, Caliskan E, Ucan Gunduz G, Gelisken O, Kaderli B, Yucel AA. Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behcet Disease. Ophthalmologica. 2018:1-5. doi: 10.1159/000490674 pmid: 30244248

Tsang AC, Virgili G, Abtahi M, Gottlieb CC. Intravitreal Dexamethasone Implant for the Treatment of Macular Edema in Chronic Non-infectious Uveitis. Ocul Immunol Inflamm. 2017;25(5):685-92. doi: 10.3109/09273948.2016.1160130 pmid: 27191685

Khurana RN, Porco TC. Efficacy and Safety of Dexamethasone Intravitreal Implant for Persistent Uveitic Cystoid Macular Edema. Retina. 2015;35(8):1640-6. doi: 10.1097/IAE.0000000000000515 pmid: 25741813

Bansal P, Agarwal A, Gupta V, Singh R, Gupta A. Spectral domain optical coherence tomography changes following intravitreal dexamethasone implant, Ozurdex(R) in patients with uveitic cystoid macular edema. Indian J Ophthalmol. 2015;63(5):416-22. doi: 10.4103/0301-4738.159870 pmid: 26139803

Pleyer U, Klamann M, Laurent TJ, Manz M, Hazirolan D, Winterhalter S, et al. Fast and Successful Management of Intraocular Inflammation with a Single Intravitreal Dexamethasone Implant. Ophthalmologica. 2014. doi: 10.1159/000368987 pmid: 25428335

Cao JH, Mulvahill M, Zhang L, Joondeph BC, Dacey MS. Dexamethasone intravitreal implant in the treatment of persistent uveitic macular edema in the absence of active inflammation. Ophthalmology. 2014;121(10):1871-6. doi: 10.1016/j.ophtha.2014.04. 012 pmid: 24907061

Zarranz-Ventura J, Carreno E, Johnston RL, Mohammed Q, Ross AH, Barker C, et al. Multicenter study of intravitreal dexamethasone implant in noninfectious uveitis: indications, outcomes, and reinjection frequency. Am J Ophthalmol. 2014;158(6):1136-45 e5. doi: 10.1016/j.ajo.2014.09.003 pmid: 25217856

Wiechens B, Nolle B, Reichelt JA. Pars-plana vitrectomy in cystoid macular edema associated with intermediate uveitis. Graefes Arch Clin Exp Ophthalmol. 2001;239(7):474-81. pmid: 11521690

Heiligenhaus A, Bornfeld N, Wessing A. Long-term results of pars plana vitrectomy in the management of intermediate uveitis. Curr Opin Ophthalmol. 1996;7(3):77-9. pmid: 10163465

Pelegrin L, de la Maza MS, Molins B, Rios J, Adan A. Long-term evaluation of dexamethasone intravitreal implant in vitrectomized and non-vitrectomized eyes with macular edema secondary to non-infectious uveitis. Eye (Lond). 2015;29(7):943-50. doi: 10.1038/eye.2015.73 pmid: 25998942


Full Text: Full Text PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.