Efficacy of intravitreal dexamethasone implant monotherapy for the treatment of macular edema in non-infectious uveitis

Authors: Rishi B. Gupta, Julius Ilin, Chloe Gottlieb.

Disclosure Block: R.B. Gupta: None. J. Ilin: None. C. Gottlieb: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Abbvie. Any direct financial payments including receipt of honoraria; Description of relationship(s); Honoraria. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Bayer. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory Board. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Bayer, Apellis, Roche/Genentech, Novartis. Funded grants or clinical trials; Description of relationship(s); Grant, Clinical Trials, Clinical Trials, Clinical Trials.

Abstract Title: Efficacy of intravitreal dexamethasone implant monotherapy for the treatment of macular edema in non-infectious uveitis

Abstract Body: 

Purpose: This study investigates the efficacy of dexamethasone intravitreal implants (DEX), a novel treatment, as monotherapy for the treatment of macular edema in non-infectious intermediate, posterior or panuveitis.

Study Design: Retrospective chart review from the University of Ottawa Eye Institute, Ottawa, Ontario, Canada.

Methods: Patients for inclusion in the study were identified by a database search. Thirty patients seen at an academic tertiary care centre for the treatment of intermediate, posterior and panuveitis with DEX were included in the study. Exclusion criteria included concomitant oral prednisone, systemic immunomodulatory treatment, or periocular steroid 6 weeks prior to the first implant. The primary outcome measure was central retinal thickness (CRT) as measured by spectral-domain optical coherence tomography (sdOCT). Secondary measures were best corrected visual acuity (BCVA) and time to failure, defined as number of months with DEX implant until an adjunct therapy is indicated, up to 12 months after the first injection. Baseline measurements of CRT and BCVA were measured within 1 month prior to intravitreal DEX implant, and follow up measurements were collected at 1-month and subsequent 3-month intervals up to 12 months after each injection.

Results: A total of 49 implants on 39 eyes of 30 patients were included in the analysis of this study. Of these, 64.1% (25 of 39) had an improvement in BCVA and 65.4% (17 of the 26 collected eyes) had a reduction in CRT. BCVA improved from 0.285μm (SE: 0.05μm) at baseline to 0.172μm (SE: 0.03μm) at 3 months and 0.182μm (SE: 0.05μm) at 12 months. Preliminary CRT data showed a decrease from 392μm (SE: 31μm) at baseline to 305μm (SE: 22μm) at 1 month and 326μm (SE: 12μm) at 12 months. Of the 39 eyes, only 4 eyes (10.2%) failed the treatment and required systemic corticosteroid therapy. The average time to failure in these patients was 7 months.

Conclusions: The DEX implant as monotherapy for macular edema in non-infectious uveitis was associated with a reduction in CRT and improvement in BCVA, with only 10.2% of patients requiring additional treatment in a 12-month period. The DEX intravitreal implant, used as a monotherapy in treatment-naïve eyes with intermediate, posterior and panuveitis, is a local corticosteroid therapy that has the potential to treat uveitis without the addition of oral corticosteroid or other immunomodulatory therapy.