Multicenter Study of Intravitreal Dexamethasone Implant in Noninfectious Uveitis: Indications, Outcomes, and Reinjection Frequency

• Published in: American journal of ophthalmology 2014-12, Vol.158 (6), p.1136-1145.e5
• Main Authors: Zarranz-Ventura, Javier, Carreño, Ester, Johnston, Robert L, Mohammed, Quresh, Ross, Adam H, Barker, Carl, Fonollosa, Alex, Artaraz, Joseba, Pelegrin, Laura, Adan, Alfredo, Lee, Richard W, Dick, Andrew D, Sallam, Ahmed
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cohort Studies; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Drug Implants; Female; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Health services; Humans; Intraocular Pressure - drug effects; Intravitreal Injections; Male; Middle Aged; Ophthalmology; Retina - pathology; Retreatment; Retrospective Studies; Software; Statistical analysis; Statistical methods; Survival analysis; Treatment Outcome; Uveitis - diagnosis; Uveitis - drug therapy; Visual Acuity - drug effects; Vitreous Body - drug effects
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2014.09.003

Purpose To identify clinical outcomes and treatment patterns of intravitreal dexamethasone implant (Ozurdex; Allergan, Inc) in noninfectious uveitis in the clinical setting. Design Multicenter retrospective cohort study. Methods Eighty-two eyes (63 patients) receiving 142 implant injections over 35 months were included. Treatment indication, uveitis diagnosis, visual acuity, intraocular pressure, vitreous haze score, central retinal thickness by optical coherence tomography, phakic status, number of injections, time to reinjection, systemic treatments, and complications data were collected. Time to visual acuity and vitreous haze score improvement as per the Standardization of Uveitis Nomenclature guidelines were also determined. Results The probability of visual acuity improvement (≥0.3 logarithm of the minimal angle of resolution units improvement) was 39% at 1 month, 49% at 3 months, 52% at 6 months, and 58% at 12 months. Eyes with baseline vitritis (vitreous haze score ≥+0.5, n = 45) had a probability of vitreous haze score improvement (2-step decrease or change from +0.5 to 0) at 2 weeks of 41%, at 1 month 63%, at 3 months 73%, at 6 months 79%, and at 12 months 88%. In eyes that completed 12-month follow-up (n = 54), 40.7% underwent 2 injections (mean time to second injection of 6.6 ± 1.9 months) and 11.2% required ≥3 injections (mean time to third injection of 11 ± 1.5 months). Conclusions Dexamethasone implant use in uveitis provides favorable visual acuity and vitreous haze score outcomes but requires repeated injections, an important consideration when choosing intraocular treatment as a route to controlling uveitis.