Dexamethasone intravitreal implant (Ozurdex) in the treatment of pediatric uveitis

Abstract

The dexamethasone (Ozurdex) implant (Allergan Inc, Irvine, CA) is an implantable biodegradable polymer containing of 0.7 mg of dexamethasone. It is approved for the treatment of non-infectious uveitis in adults. To our knowledge its use in the treatment of pediatric uveitis has not been reported. A retrospective chart review of all pediatric patients at our institution with noninfectious posterior uveitis unresponsive to standard treatment that received the Ozurdex implant. Thirteen eyes of 10 patients (mean age 9.5 years range 4-12 years) underwent one to three Ozurdex implants (total 18 implants) in 2011-2012. Seven patients (10 eyes) had idiopathic intermediate or posterior uveitis. The remaining 3 patients had sympathetic ophthalmia, juvenile idiopathic arthritis and sarcoidosis. All patients were uncontrolled with standard treatments including topical corticosteroids, subtenon’s corticosteriod injections and systemic corticosteroid and/or immune-modulation. Improvement was noted initially in all patients. Initial implantation allowed for reduction of topical treatment in 8/13 eyes. Four eyes (31%) underwent 2 or 3 implantations for recurrent inflammation. Complications included implant migration into the anterior chamber in aphakic eyes (5 implants), increased IOP (>10 mm Hg from baseline)3 eyes, and progression of a preexisting cataract (1 eye). The Ozurdex implant should be considered in pediatric patients with refractory uveitis. The adverse events identified in our study are similar to those identified in adult studies. The dexamethasone intravitreal implant can be used safely and effectively in the pediatric population as an adjunctive treatment for intraocular inflammation in noninfectious intermediate and posterior uveitis.