The Use of Sustained Release Intravitreal Steroid Implants in Non-Infectious Uveitis Affecting the Posterior Segment of the Eye

Abstract

The treatment of non-infectious uveitis affecting the posterior segment of the eye has been revolutionized by the development of sustained-release corticosteroid implants over the past decade. Their use is now supported by healthcare systems that have licensed and commissioned them on the basis of the high-quality randomised controlled trials that formed part of their development and which have informed clinicians as to their benefits and risks. In particular, they have provided an alternative mode of treatment for patients who do not wish to be systemically immunosuppressed, or in whom such immunosuppression is less desirable, such as those with unilateral disease or those with concurrent illnesses such as diabetes mellitus, renal disease or osteoporosis that are negatively impacted by systemic corticosteroids or other immunosuppressive agents. In this article, we review the evidence for the use of the major licensed corticosteroid implants and assess the advantages and disadvantages of each.

Keywords: Corticosteroids; Iluvien; Local therapy; Ozurdex; Uveitis.

Fig. 1

Representative optical coherence tomography (OCT) scans (left-hand panel right eye, right-hand panel left eye): top row: pre-local therapy on tocilizumab and oral corticosteroids; second row: after initial Ozurdex therapy; third row: typical relapse 4 months after Ozurdex; bottom row: 1-year post-Iluvien implants to both eyes. Iluvien was implanted whilst the disease was controlled in order to provide longer-lasting disease control without further relapse