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Review and update of intraocular therapy in noninfectious uveitis

Sallam, Ahmeda; Taylor, Simon R.J.b; Lightman, Sueb

Current Opinion in Ophthalmology: November 2011 - Volume 22 - Issue 6 - p 517–522
doi: 10.1097/ICU.0b013e32834bbd68
Ocular manifestations of systemic disease: Edited by Russell W. Read
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Purpose of review To review new clinically relevant data regarding the intraocular treatment of noninfectious uveitis.

Recent findings Triamcinolone acetonide, the most commonly used intravitreal corticosteroid for treatment of uveitis and uveitic macular oedema has a limited duration of action and is associated with a high risk of corticosteroid-induced intraocular pressure (IOP) rise and cataract. Recent advances have led to the development of sustained-release corticosteroid devices using different corticosteroids such as dexamethasone and fluocinolone acetonide. Treatment options for patients who have previously exhibited corticosteroid hypertensive response have also expanded through the use of new noncorticosteroid intravitreal therapeutics such as methotrexate and antivascular endothelial growth factor (anti-VEGF) agents.

Summary Ozurdex dexamethasone implant appears to have a better safety profile, and a slightly long-lasting effect than triamcinolone acetonide. The Retisert implant allows the release of corticosteroids at a constant rate for 2.5 years, but it requires surgical placement and its use is associated with a very high risk of cataract and requirement for IOP-lowering surgery. For patients who are steroid responders, methotrexate may offer a better alternative to corticosteroid treatment than anti-VEGF agents, but controlled trials are required to confirm this.

aGloucestershire Eye Unit, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire

bUCL Institute of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK

Correspondence to Professor Sue Lightman, PhD, FRCP, FRCPEd, FRCOphth, FMedSci, FARVO, UCL Institute of Ophthalmology, Moorfields Eye Hospital, London EC1 V 2PD, UK Tel: +44 20 7566 2266; fax: +44 20 7251 9350; e-mail: s.lightman@ucl.ac.uk

© 2011 Lippincott Williams & Wilkins, Inc.