Abstract
Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino‐vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer‐term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the types of periocular steroid delivery, their clinical applications in ophthalmology and their side effects.
Highlights
The first use of corticosteroids in ophthalmology by Gordon and McLean[1] in the 1950s was a landmark event that revolutionized the management of inflammatory eye disease
A total of 1267 patients were randomized to receive a single treatment of dexamethasone intravitreal implant (DII) 0.7, 0.35 mg, or sham procedure. Both DII groups performed significantly better than the sham arm in the time to reach a ≥15 letter improvement in BCVA, proportion of patients achieving a ≥15 letter improvement in BCVA, mean BCVA and proportion of patients losing ≥15 letters
Postoperative surgical or medical interventions to trabeculectomy was associated with less likelihood of postoperative needling and less need for intraocular pressures (IOPs)-lowering medication
Summary
The first use of corticosteroids in ophthalmology by Gordon and McLean[1] in the 1950s was a landmark event that revolutionized the management of inflammatory eye disease. The therapeutic effect of glucocorticoids are mediated via the glucocorticoid receptor in the cytosol which upon activation, undergoes conformational changes and translocate toward the cell nucleus. This activated glucocorticoid receptor signals the transactivation or trans-repression of gene transcription factors which cause both therapeutic and side effects. The anti-inflammatory effect of steroids is caused by inhibiting the transcription of inflammatory and immune genes These actions block the release of arachidonic acid and its subsequent eicosanoids (prostaglandins, thromboxanes, prostacyclins and leukotrienes).[5] This affects the FIGURE 1 Classification of steroids and actions.
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