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Intraocular corticosteroids for posterior segment disease: 2012 update.
Daniel F Kiernan1, William F Mieler
1Ophthalmic Consultants of Long Island, Rockville Centre, NY, USA.
Expert Opinion on Pharmacotherapy
|July 13, 2012
Summary
Intraocular corticosteroids show promise for treating retinal diseases like diabetic macular edema (DME) and uveitis. While sustained-release implants are approved for some conditions, side effects like cataracts and glaucoma require careful consideration.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Pharmacology
Background:
- Diabetic macular edema (DME), cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO), and uveitis cause significant visual impairment globally.
- Intraocular corticosteroids are considered for patients with these conditions, with ongoing clinical trials for novel formulations.
- Off-label use of corticosteroids for these indications has a long history.
Purpose of the Study:
- To review the use of clinical trials (CTs) for vitreoretinal (VR) diseases.
- To discuss the application of corticosteroids in treating VR diseases, including specific agents and delivery methods.
Main Methods:
- Review of clinical trials for vitreoretinal diseases.
- Discussion of corticosteroid agents: dexamethasone, fluocinolone acetonide, triamcinolone acetonide, and intravitreal implants.
- Analysis of treatment efficacy and side effects.
Main Results:
- Intravitreal corticosteroids may offer benefits for DME, RVO, and uveitis compared to standard therapies.
- Combination therapy including intravitreal corticosteroids may help exudative AMD unresponsive to standard treatment.
- Sustained-release implants are approved for posterior uveitis and RVO with macular edema.
Conclusions:
- Intraocular corticosteroids can be beneficial for various retinal conditions, but carry risks such as cataract and glaucoma.
- Most agents have limited duration of action and significant side effects.
- Current intravitreal corticosteroid use for DME remains off-label.
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