Comparing the Efficacy of Intravitreal Dexamethasone and Time-displaced Fluocinolone Acetonide on Central Retinal Thickness in Patients with Uveitis

BACKGROUND

To compare the efficacy of intravitreally administered dexamethasone (Dex) and subsequent time-displaced fluocinolone acetonide (FA) on central subfield thickness (CST) in eyes with noninfectious uveitis.

METHODS

Retrospective analysis of twenty-three eyes (18 patients) subsequently receiving intravitreal Dex and FA implants. The main outcome measures were CST, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and status of inflammation.

RESULTS

CST (Dex: p < .0001; FA: p = .0008) and BCVA (Dex: p = .0009; FA: p = .0005) improved significantly with both implants. Significantly better effects were noted with Dex for absolute and relative CST reduction (p = .0089 and p = .0051, respectively). Final BCVA did not differ between groups (p = .1893). Dex significantly increased IOP, whereas FA did not. One eye was actively inflamed after Dex and FA injection at follow-up (inflamed eyes before injection: [Dex: 2; FA: 6]).

CONCLUSION

Both implants significantly reduced CST and induced a significant gain in visual acuity. Dex might be more effective in reducing CST.

Efficacy and safety of intravitreal and periocular injection of corticosteroids in non-infectious uveitis: a systematic review

Uveitis is among the leading causes of visual loss in the working age population. In non-infectious uveitis, corticosteroids are the first line therapy. We sought to review systematically the evidence regarding the regional corticosteroid delivery modalities in the treatment of non-infectious uveitis. A five-database search (Pubmed, ISI Web of Science, Cochrane, ClinicalTrials.gov, and Scopus) was performed from inception to February, 2021. Nineteen studies with a total of 1935 eyes of 1753 patients were selected from 8922 abstracts retrieved by the initial search. The most frequently compared regimens were intravitreal triamcinolone acetonide injection and orbital floor triamcinolone acetonide injection (2 studies), intravitreal triamcinolone acetonide injection and posterior sub-Tenon triamcinolone acetonide injection (2 studies), and posterior sub-Tenon triamcinolone acetonide injection with the intravitreal dexamethasone implant (2 studies). Our results show that the intravitreal injection of corticosteroids is more effective, but is associated with more adverse events, than periocular injection. Some evidence supports the use of subconjunctival triamcinolone acetonide over intravitreal/periocular triamcinolone acetonide. Moreover, the overall results of 0.59 mg dosage of the intravitreal fluocinolone acetonide implant were superior to those from the 2.1 mg dose. The evidence, however, is not robust and further studies with standardized outcomes are warranted.

Efficacy and Safety of Corticosteroid Implants in Non-infectious Uveitis: A Systematic Review with Network Meta-analysis

BACKGROUND/AIMS

To compare different existent implants for noninfectious uveitis.

METHODS

We performed a systematic review of randomized clinical trials (RCTs), searching in five electronic databases and screening reference lists of included studies and relevant reviews. We performed network meta-analysis to compare 0.18 mg fluocinolone acetonide implants, 0.70 mg and 0.35 mg dexamethasone implants, and sham procedures.

RESULTS

Eight RCTs were included in this systematic review, of which three articles from two studies (n = 358 patients) were included in network meta-analysis. The 0.70 mg dexamethasone implant (at 1.5 months) was associated with better results than the 0.18 mg fluocinolone acetonide implant (at 1 month) at improving vitreous haze grading (RR = 2.96; 95%CI = 1.23-7.07), and with less frequently development of cataracts at 12 (RR = 0.36; 95%CI = 0.17; 0.79) and 36 months (RR = 0.37; 95%CI = 0.20; 0.71).

CONCLUSIONS

In the short term, the 0.70 mg dexamethasone implant is superior at improving vitreous haze, and shows lower risk of cataracts. However, additional RCTs with standardized outcomes are needed.

Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment

The treatment for rhegmatogenous retinal detachment (RRD) is surgery, including pars plana vitrectomy (PPV) and scleral buckling (SB). Despite surgical advances, degeneration of the photoreceptors and post-operative complications, such as proliferative vitreoretinopathy (PVR), often occurs as the result of inflammation, preventing complete visual recovery or causing RRD recurrence. There is increasing evidence that in the presence of RRD, the activation of inflammatory processes occurs and the surgery itself induces an inflammatory response. This comprehensive review focuses on the use of different formulations of corticosteroids (CCS), as an adjunctive treatment to surgery, either PPV or SB, for RRD repair. The purpose was to review the efficacy and safety of CCS in improving functional and anatomical outcomes and in preventing postoperative complications. This review is organized according to the timing of CCS administration: preoperative, intraoperative, and postoperative. The evidence reviewed supported the role of the pre-operative use of CCS in the treatment of combined RRD and choroidal detachment (CD), reducing CD height. No solid consensus exists on intraoperative and postoperative use of CCS to treat and prevent postoperative complications. However, a large randomized clinical trial including more than 200 eyes suggested that oral prednisone after surgery decreases the rate of postoperative grade B PVR.

The Dexamethasone Intravitreal Implant for Noninfectious Uveitis: Practice Patterns Among Uveitis Specialists

PURPOSE

To describe the practice patterns and perceptions of uveitis specialists regarding the use of the intravitreal dexamethasone (DEX) implant for the treatment of noninfectious uveitis.

METHODS

We invited uveitis specialists to participate in an anonymous online survey.

RESULTS

Among the 45 respondents, 76.5% identified uveitic macular edema as the most common clinical finding for which they use the DEX implant. The most common contraindications to DEX implantation were aphakia and glaucoma requiring >2 medications. Nearly two-thirds (64.3%) felt that the advent of the DEX implant did not change the frequency with which they used the fluocinolone acetonide (FA) implant, and about one-third (32.3%) preferred to use at least one DEX implant, before committing a patient to an FA implant.

CONCLUSIONS

Uveitis physicians use the DEX implant for a wide range of clinical findings and uveitic diagnoses. There was no clear consensus on preferences regarding the use of DEX versus FA implants.

Fluocinolone acetonide partially restores the mineralization of LPS-stimulated dental pulp cells through inhibition of NF-κB pathway and activation of AP-1 pathway

BACKGROUND AND PURPOSE

Fluocinolone acetonide (FA) is commonly used as a steroidal anti-inflammatory drug. We recently found that in dental pulp cells (DPCs) FA has osteo-/odonto-inductive as well as anti-inflammatory effects. However, the mechanism by which FA induces these effects in DPCs is poorly understood.

EXPERIMENTAL APPROACH

The effect of FA on the mineralization of DPCs during inflammatory conditions and the underlying mechanism were investigated by real-time PCR, Western blot, EMSA, histochemical staining, immunostaining and pathway blockade assays.

KEY RESULTS

FA significantly inhibited the inflammatory response in LPS-treated DPCs not only by down-regulating the expression of pro-inflammation-related genes, but also by up-regulating the expression of the anti-inflammatory gene PPAR-γ and mineralization-related genes. Moreover, histochemical staining and immunostaining showed that FA could partially restore the expressions of alkaline phosphatase, osteocalcin and dentin sialophosphoprotein (DSPP) and mineralization in LPS-stimulated DPCs. Real-time PCR and Western blot analysis revealed that FA up-regulated DSPP and runt-related transcription factor 2 expression by inhibiting the expression of phosphorylated-NF-κB P65 and activating activator protein-1 (AP-1) (p-c-Jun and Fra-1). These results were further confirmed through EMSA, by detection of NF-κB DNA-binding activity and pathway blockade assays using a NF-κB pathway inhibitor, AP-1 pathway inhibitor and glucocorticoid receptor antagonist.

CONCLUSIONS AND IMPLICATIONS

Inflammation induced by LPS suppresses the mineralization process in DPCs. FA partially restored this osteo-/odonto-genesis process in LPS-treated DPCs and had an anti-inflammatory effect through inhibition of the NF-κB pathway and activation of the AP-1 pathway. Hence, FA is a potential new treatment for inflammation-associated bone/teeth diseases.

Fluocinolone acetonide intravitreal implant for the treatment of diabetic macular edema

Diabetic macular edema (DME) remains one of the leading causes of moderate to severe vision loss. Although laser photocoagulation was the standard of care for several years, few patients achieved significant improvements in visual acuity. As a result, several pharmacotherapies and surgeries have been investigated. The fluocinolone acetonide devices are one of the latest therapies considered for the treatment of DME. Despite bringing significant improvements in visual acuity, fluocinolone devices are associated with cataract formation, increased intraocular pressure (IOP), and surgery to lower IOP. Due to the risk of complications, fluocinolone acetonide devices should be considered only in cases refractive to first-line therapies. In this review, we evaluate current and emerging therapies for DME, with special emphasis on fluocinolone acetonide intravitreal devices.