Intravitreal dexamethasone implant for the treatment of persistent Uveitic Macular Edema

Abstract

 

Purpose

 

To evaluate the effects of intravitreal dexamethasone (DEX) implant (Ozurdex®; Allergan, Inc., Irvine, CA) for the treatment of persistent uveitic macular edema (ME)

 

Methods

 

Medical records of 37 patients with persistent uveitic ME treated with intravitreal DEX implant were reviewed. Patients had an inadequate control of ME despite differents therapies.The main outcome measure was reduction in central retinal thickness (CRT). Secondary outcomes were: improvement in BCVA and decrease in uveitis activity.Tolerability of the implant was assessed.

 

Results

 

Fourty seven eyes of 37 patients were included in the analysis. Mean postoperative follow-up was 11.9 months (range 2-24). At the time of intravitreal injection 21 eyes (44,7%) were vitrectomized and 26 eyes (55,3%) were non-vitrectomized. In 5 eyes combined treatment with pars plana vitrectomy and DEX implant injection and the end of the surgery was performed.The mean baseline CRT was 519,89 μm, decreased to 331,79 μm at 3 months (p = 0,0001), and then reached 394.07 μm at 6 months (p = 0.009).The mean BCVA improved to 0.46 ± 0.30 logMAR (p = 0.0001) at 6 month. Uveitis activity decreased in all patients after the implant. Similar CRT reductions with DEX implant treatment for uveitic ME in vitrectomized and non-vitrectomized eyes were found. Eleven eyes received 2 DEX implants and 4 eyes received 3 DEX implants. All eyes with a 2nd or 3th implant improved CRT. An increase in intraocular pressure (IOP) of 10 mm Hg or more was seen in 21,2% (10/47) of eyes. Cataract surgery was performed in 2 eyes. Anterior chamber displacement of the implant occurred in 3 eyes.

 

Conclusions

 

Intravitreal DEX implant seems to be a safe and effective treatment for patients with persistent uveitic ME. Our results suggest that efficacy of the implant in difficult-to-treat vitrectomized eyes with uveitic ME. Repeated intravitreal DEX implant may produce long-term clinically meaningful benefits.

 

 

OCT changes in a woman 21 years old with macular edema secondary to juvenil idiopathic arthritis associated uveitis. Thee implants were injected with a long-term clinically benefit

 

 

Optical coherence tomography (OCT) before combined pars plana vitrectomy (PPV) and DEX-intravitreal implant injection in a patient with uveitic macular edema and epiretinal membrane.OCT after combined treatment showed decrease of CRT at 1 month,3 month and 14 month

 

Keywords: 746 uveitis-clinical/animal model • 505 edema • 487 corticosteroids