Combination therapy

Intravitreal dexamethasone combined with systemic immunosuppressive therapy is an effective approach to the treatment of uveitis

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The combination of intravitreal dexamethasone (Ozurdex®, Allergan) to induce control of intraocular inflammation and immunosuppressive therapy to maintain disease quiescence appears to be an effective approach to managing uveitis affecting the posterior segment, suggest the results of a study presented by Dr Christine Goodchild at the Annual Conference of the Irish College of Ophthalmologists in Galway, Ireland. “Our study showed similar outcomes when compared to other international studies including the HURON study. However, our study had a much higher number of immunosuppressed patients,” said Dr Goodchild, Royal Victoria Eye and Ear Hospital, Dublin. The non-comparative, retrospective study included 43 eyes of 37 patients with non-infectious uveitis who were treated with Ozurdex from October 2013 to March 2018 under the care of Prof C. Murphy and Mr D. Kilmartin. The types of uveitic conditions included panuveitis in 52% of cases, posterior uveitis in 22% and intermediate in 21%. Dr Goodchild noted that 94% of patients were receiving systemic immunotherapy at the time of intravitreal dexamethasone injection. They included 9% who were receiving oral 
corticosteroids only, 76% who were receiving 
oral steroids and steroid-sparing immuno-suppressant and 9% who were receiving steroid-sparing immunosuppressant alone. During the four-and-a-half-year study period, the patients received a total of 79 inserts, equivalent to a mean of 2.14 injections. The mean interval between the first and second Ozurdex insert was 11.5 months and median of 6.7 months. Fifty-six per cent of patients received only one insert, 26% received two, 9% received three and 9% received more than three. The mean logMAR BCVA improved significantly, from a baseline value of 0.65 to 0.47 at one month and 0.42 at three months (p<0.05). Mean central foveal thickness also improved significantly, decreasing from a baseline value of 474.5µm to 392.2µm at nine months (p<0.05). BIO scores also improved significantly from 1.81 at baseline to 0.68 at three months (p<0.00) and was significantly sustained to nine months at 1.15. Dr Goodchild noted that the adverse event profile following Ozurdex implantation was similar to that reported in randomised controlled trials. There was a transient rise in IOP in the first month, and 15% of additional patients needed IOP-lowering drops. In addition, 18.60% of patients became newly pseudophakic during the study, 11.63% of patients developed a new cataract and 13.95% had worsening of their cataract post-implant. Christine Goodchild: cgoodchild@rcsi.com
Tags: combination therapy, glaucoma