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Corticosteroid implants for chronic non-infectious uveitis.

Amit Reddy1, Su-Hsun Liu1,2, Christopher J Brady3,4

  • 1Department of Ophthalmology, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, Colorado, USA.

The Cochrane Database of Systematic Reviews
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Summary

Corticosteroid implants may reduce uveitis recurrence and improve vision, but evidence on superiority is limited. These implants may increase risks of cataract progression and elevated intraocular pressure, requiring interventions.

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Area of Science:

  • Ophthalmology
  • Inflammatory Diseases
  • Medical Implants

Background:

  • Uveitis, a group of intraocular inflammatory diseases, is a leading cause of vision loss, particularly in the working-age population.
  • Corticosteroids are the primary treatment for non-infectious uveitis, administered via various methods including intravitreal implants.

Purpose of the Study:

  • To evaluate the efficacy and safety of intravitreal steroid implants for chronic non-infectious posterior, intermediate, and panuveitis.

Main Methods:

  • Systematic review of randomized controlled trials comparing fluocinolone acetonide (FA) or dexamethasone (DEX) intravitreal implants against standard care or sham procedures.
  • Included studies with at least six months follow-up, focusing on participants with chronic non-infectious uveitis and vision better than hand-motion.

Main Results:

  • Corticosteroid implants showed a potential 60% reduction in uveitis recurrence (low-certainty evidence) and improved best-corrected visual acuity (BCVA) at six months versus sham.
  • At 24 months versus standard care, implants likely reduced recurrence by 54% (low-certainty evidence) but had little effect on BCVA (low-certainty evidence).
  • Implants may increase risks of cataract formation/progression and elevated intraocular pressure (IOP), necessitating interventions, but did not increase risks of endophthalmitis or retinal detachment.

Conclusions:

  • Limited confidence exists in the superiority of local corticosteroid implants over sham or standard therapy for reducing uveitis recurrence.
  • Evidence suggests implants increase risks of cataract progression and elevated IOP, requiring monitoring and potential interventions.
  • Future trials need to investigate varied implant doses and durations, measuring universally defined core outcomes at comparable time points.