Efficacy of a Dexamethasone Implant for the Treatment of Refractory Cystoid Macular Oedema in Non-Infectious Uveitis

Abstract

To evaluate the efficacy of an intravitreal dexamethasone implant (Ozurdex®) in patients with cystoid macular oedema (CME) suffering from non-infectious uveitis. Monocentric, retrospective, single-arm analysis in 49 patients (59 implanted eyes) with inactive uveitis, in whom CME had been unresponsive to corticosteroids and/or immunosuppressants and systemic acetazolamide, and who received a dexamethasone implant. Patients were followed up at 6, 12 and 24 weeks after unilateral (n = 39)/bilateral (n = 10) implantation. The primary outcome measure was central foveal thickness (CFT), as measured by Spectralis optical coherence tomography (OCT); secondary outcome measures were improvement in best-corrected visual acuity (BCVA), laser flare photometry and safety measures, including intraocular pressure (IOP) and cataract progression. At 6, 12 and 24 weeks, mean CFT was reduced (≥ 20 %) in 68, 44 and 45 % and BCVA improved (≥ 2 lines) in 47, 40 and 26 %, respectively, as compared to baseline. At 6, 12 and 24 weeks, significant flare reduction was observed in 70, 41, and 42 %, respectively. Cumulative cataract progression was observed in 12, 18 and 31 % at 6, 12 and 24 weeks, respectively. IOP ≥ 22 mmHg was noted in 5 % at baseline and in 21, 3, and 0 % at 6, 12 and 24 weeks, respectively. In uveitis patients with CME refractory to systemic anti-inflammatory drugs, the dexamethasone implant improves CME transiently. However, IOP increase and cataract progression are common side effects.