Efficacy and safety of different intraocular therapies for non-infectious uveitis: A network meta-analysis

Systemic corticosteroids and immunosuppressants remain the standard first-line therapy for non-anterior, non-infectious uveitis (NIU), but prolonged use carries significant systemic and ocular adverse effects. Several intraocular agents have recently emerged as effective alternative or adjunctive options. Our meta-analysis included 9 randomized controlled trials and 1 retrospective case series, investigating the efficacy and safety profiles of intravitreal fluocinolone acetonide implant (FAi), intravitreal dexamethasone implant, intravitreal or suprachoroidal triamcinolone acetonide (SCTA), intravitreal methotrexate, intravitreal ranibizumab, and standard of care (SOC) for NIU. Our results demonstrated that all the studied intraocular agents excluding ranibizumab demonstrated a better best-corrected visual acuity gain compared to SOC at 6 months. The 4 mg SCTA demonstrated the greatest central macular thickness reduction surpassing other intraocular steroid therapies and SOC at 6 months for uveitic macular edema. With regards to side effects, 0.59 mg FAi was associated with a higher risk of 2-year and 3-year intraocular pressure elevation ≥ 10 mmHg when compared to SOC. Understanding the advantages and limitations of intraocular therapies is essential for initiating personalized treatment strategies in NIU.