Fluocinolone Acetonide Versus Dexamethasone Intravitreal Implants for Non-Infectious Posterior-Segment Uveitis:...

To compare 12-month real-world outcomes and safety profiles of the fluocinolone acetonide intravitreal implant (FAi) versus the dexamethasone intravitreal implant (DEX) in non-infectious posterior-segment uveitis.

Single-center retrospective cohort study of eyes treated with FAi or DEX and followed for ≥12 months. Best-corrected visual acuity (BCVA; logMAR), intraocular pressure (IOP), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were assessed at baseline and 1, 3, 6, and 12 months. Injection frequency, uveitis recurrence, and adverse events were recorded.

A total of 117 eyes were analyzed (FAi, n = 53; DEX, n = 64). Both groups showed significant improvements in BCVA, CMT, and SFCT from baseline. At 6 and 12 months, CMT was lower with FAi than with DEX (p = 0.010 and p = 0.003), and SFCT was lower at 6 months (p = 0.011), consistent with more sustained anatomical control. DEX showed greater BCVA improvement at 1 month (p = 0.047); from months 3-12, visual outcomes were comparable. FAi required fewer injections (mean 1.0 vs 1.6; p < 0.001) and had a lower recurrence rate (13.2% vs 51.6%; p < 0.001). IOP elevation and the need for laser or incisional surgery were greater with FAi.

In this real-world cohort, both FAi and DEX provided clinically meaningful benefits, displaying complementary rather than competing profiles. FAi was associated with more sustained anatomical control and fewer injections but greater IOP management requirements, whereas DEX offered more rapid early visual improvement and a more favorable IOP profile. These hypothesis-generating findings support individualized implant selection and require prospective validation.