Matthew McCartney1,2, Peter McCluskey3,4, Sophia Zagora3,4. 1. Department of General Surgery, St Vincent's Hospital, Sydney, Victoria, Australia. 2. University of New South Wales, Sydney, New South Wales, Australia. 3. Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia. 4. Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia.
Abstract
IMPORTANCE: Inflammatory-mediated cystoid macular oedema (CMO) is the most common inflammatory-mediated threat to vision in non-infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained-release dexamethasone (DEX) implant devices provide localized therapy. BACKGROUND: The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort. DESIGN: A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital. PARTICIPANTS: Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies. METHODS: Cases from March 2012 and March 2018 were retrospectively selected with follow-up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow-up was 32 weeks. MAIN OUTCOME MEASURES: The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure and medication regimens. RESULTS: Ninety-five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P < .01). Sixty-one percent demonstrated improved BCVA at week 8 (P < .05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low. CONCLUSIONS AND RELEVANCE: In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort.
IMPORTANCE: Inflammatory-mediated cystoid macular oedema (CMO) is the most common inflammatory-mediated threat to vision in non-infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained-release dexamethasone (DEX) implant devices provide localized therapy. BACKGROUND: The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort. DESIGN: A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital. PARTICIPANTS: Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies. METHODS: Cases from March 2012 and March 2018 were retrospectively selected with follow-up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow-up was 32 weeks. MAIN OUTCOME MEASURES: The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure and medication regimens. RESULTS: Ninety-five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P < .01). Sixty-one percent demonstrated improved BCVA at week 8 (P < .05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low. CONCLUSIONS AND RELEVANCE: In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort.