Researchers Compare Intravitreal Implants for Non-Infectious Posterior Uveitis

There were no significant differences between dexamethasone and fluocinolone acetonide intravitreal implants in controlling inflammation; however, the latter is considered more difficult to use.

A study presented at the annual Association for Research in Vision and Ophthalmology (ARVO) Virtual Meeting showed no significant differences between dexamethasone intravitreal implant (ZURDEX) and fluocinolone acetonide intravitreal implant (ILUVIEN 0.19 mg) in terms of controlling non-infectious posterior uveitis (NIPU) inflammation

However, the investigators noted other key differences, such as efficiency and costs.

Led by Didar Abdula, of Royal Surrey Hospital, UK, the investigative team primarily sought to evaluate the effects of switching from the former therapeutic option to the latter—especially considering that little data exists comparing the two implants. To do this, they retrospectively collected information from medical records and ocular coherence tomography images on patients who used who used either or both implants.

They evaluated visual acuity, central macular thickness, intraocular pressure (IOP), as well as any complications that occurred 3 months prior to or following treatment.

The primary outcomes of the study were control of inflammation, measured by visual acuity and central macular thickness, and need for rescue treatment.

Overall, a total of 14 eyes were examined from 8 patients. Analysis revealed that both treatments were effective in controlling inflammation—as evidenced by the lack of any significant changes in visual acuity before and after switching from the dexamethasone (post-treatment, visual acuity: 0.3-0.2 logMAR) to the fluocinolone acetonide intravitreal implant (post-treatment, visual acuity: 0.1-0.2).

Patients who received either treatment experienced improvements in central macular thickness. As such, those who received dexamethasone improved from an average of 374 μm pre-treatment to 317 μm at 3 months post-treatment. Those who received fluocinolone acetonide intravitreal implant improved from 348 μm to 332 μm.

However, a rise in IOP was observed in both treatment groups—patients who received dexamethasone saw a rise from 12 mmHg to 17 mg, while those who received fluocinolone acetonide saw a more pronounced rise from 14 mmHg to 24 mmHg. Further, a slower restoration of vison—as reported by patients—was noted for fluocinolone acetonide when compared with previous implants of dexamethasone.

Among patients who those who received fluocinolone acetonide, 3 patients (6 eyes) required selective laser trabeculoplasty, trabeculectomy, and glaucoma drops as treatment.

From a physician perspective, a fluocinolone acetonide injector was considered to be less efficient and more difficult to use—requiring more preparation—than a dexamethasone injector.

“Price comparison between the 2 implants is also a factor that needs considering,” Abdula and colleagues argued. They noted fluocinolone acetonide as more expensive that dexamethasone, with the former costing around £5,500 and the latter costing £870 per implant. Further, a median of 3 dexamethasone implants were required for the 3 years prior to switching, thus amounting to £2,610.

The study, “OZURDEX® (dexamethasone intravitreal implant) vs ILUVIEN® (fluocinolone acetonide intravitreal implant) 0.19 mg in non-infectious posterior uveitis (NIPU),” was presented a ARVO 2021.