Consecutive Dexamethasone-Fluocinolone Acetonide Therapy in Non-Infectious Uveitic Macular Edema: Real-World Outcomes

To evaluate the efficacy and durability including a consecutive intravitreal corticosteroid treatment strategy involving dexamethasone (DEX) followed by fluocinolone acetonide (FAc), in non-infectious uveitis with macular edema (UME).

This real-world study included 80 eyes from 62 patients, receiving a total of 164 intravitreal injections (124 DEX and 40 FAc). Functional and anatomical outcomes were assessed using best-corrected visual acuity (BCVA) and central macular thickness (CMT). Longitudinal associations were analyzed using linear mixed-effects models to account for clustering at the patient and eye levels. Outcomes also included treatment response, durability, and retreatment intervals.

DEX implantation resulted in rapid and significant improvements in BCVA and CMT, with peak effects observed at approximately 4 weeks; however, anatomical benefits were often time-limited, necessitating reinjection. FAc implantation provided sustained anatomical stabilization, low retreatment rates, and prolonged durability, with a median retreatment interval of 35 months. Eyes receiving DEX followed by FAc achieved effective long-term disease control and a reduced treatment burden. Adverse events, including intraocular pressure elevations, were transient and manageable.

A consecutive DEX-to-FAc treatment strategy offers sustained disease control and may reduce treatment burden in patients with chronic disease.