Dexamethasone Inserts in Noninfectious Uveitis A Single-Center Experience

Purpose: To report the effectiveness of repeated intravitreal dexamethasone (DEX) inserts in noninfectious uveitis patients. Design: Prospective, single-center, interventional clinical trial between February 2010 and March 2015. Participants: Patients with noninfectious uveitis with cystoid macular edema and/or vitreitis. Methods: Patients were treated with a 700-mu g intravitreal DEX insert (Ozurdex; Allergen, Inc., Irvine, CA). Follow-up visits were scheduled 1, 3, and 6 months after injection. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze (VH) score, intraocular pressure (IOP), and adverse events were recorded. Main Outcome Measures: Primary outcome was the reduction of CRT. Secondary outcome was the improvement in BCVA and reduction of VH. Results: In total, 109 eyes of 76 patients received 298 DEX inserts. Fifty-two patients were women (68%). The mean age of all participants was 57 years (range, 24-88 years). More than 3 DEX inserts were injected into 44% of eyes. Mean number of injections were 1.54 +/- 0.5 (standard deviation [SD]), 1.98 +/- 0.84, and 2.46 +/- 1.1 over 12, 18, and 24 months, respectively. Central retinal thickness decreased significantly (P < 0.001) from 465 tm at baseline to 318, 342, and 388 tm after 1, 3, and 6 months, respectively. Similar trends were seen in eyes receiving a second, third, and fourth DEX insert. Patients with idiopathic uveitis and sarcoidosis benefited well from DEX inserts. The greatest overall benefit was achieved in patients with no systemic treatment and patients receiving antimetabolites and cyclosporin A. A significant VH score reduction was documented in 44% of eyes after 1 month. A gain of more than 3 lines in BCVA was recorded in 31% to 37%, 26% to 39%, and 8% to 32% of eyes after 1, 3, and 6 months, respectively. A transient rise in mean IOP after 1 month (P < 0.001) and after 3 months (P = 0.001) was seen. Conclusions: The repeated longer-term administration of DEX inserts in noninfectious uveitis patients, either alone or in combination with other therapies, led to improved CRT, BCVA, and VH. Underlying diseases and concomitant systemic therapy seem to have an impact on overall treatment benefit. Ocular complications were reversible and were managed by local treatment, with exception of cataract formation. (C) 2018 by the American Academy of Ophthalmology