Ermal Simaku, Megi Popa
In this selected real-world cohort, dexamethasone implant monotherapy was associated with significant anatomical improvement and early functional improvement, with high 12 month follow-up completeness. The initial implant provided a clinically useful but time-limited treatment effect, and repeat implantation was required in a subset of eyes. These findings support dexamethasone implant as a local treatment strategy for selected patients with uveitic macular edema while emphasizing the need for monitoring of ocular steroid-related adverse effects and individualized long-term inflammatory management.
BACKGROUND: Uveitic macular edema is a major cause of visual impairment in intermediate, posterior, and panuveitis. Local corticosteroid therapy can control posterior-segment inflammation while avoiding concomitant systemic corticosteroid exposure in selected patients. This study evaluated the anatomical, functional, pressure-related, and durability outcomes of the 0.7 mg dexamethasone intravitreal implant (Ozurdex) used as local monotherapy for macular edema secondary to non-infectious uveitis.
METHODS: This single-center retrospective cohort study included 21 patients (28 eyes) treated between September 2023 and April 2026. Etiologies were idiopathic uveitis in 18 patients and sarcoidosis, Behçet disease, and psoriatic arthritis in one patient each. All eyes were naïve to local ocular therapy for uveitic macular edema, and the dexamethasone implant was administered within 1 week of documented diagnosis. Patients receiving concomitant systemic corticosteroids or systemic immunomodulatory therapy during dexamethasone implant treatment were excluded. Outcomes included best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP), repeat implantation, cataract formation, and time to first treatment failure. Follow-up was assessed at approximately 1, 3, 6, 9, and 12 months.
RESULTS: Thirty-three implants were administered in 28 eyes of 21 patients. Seven patients were treated bilaterally because macular edema involved both eyes; the remaining 14 were treated unilaterally because macular edema was present in only one eye. Twenty-five of 28 eyes met SUN criteria for active non-anterior uveitis at baseline. Mean CRT decreased from 407 µm at baseline to 334 µm at 1 month (p = 0.049), 310 µm at 6 months (p = 0.020), and 318 µm at 12 months (p = 0.009). Mean BCVA improved from 0.298 logMAR at baseline to 0.181 logMAR at 1 month (p = 0.023) and remained numerically better at 12 months (0.188 logMAR; p = 0.057). Mean IOP increased from 18.20 to 23.20 mmHg at 1 month (p = 0.001) and subsequently returned toward baseline. Three patients developed an IOP > 30 mmHg; all were controlled with topical IOP-lowering medication, and none required glaucoma laser or surgery. At 12 months, CRT, BCVA, and IOP data were available for 26 of 28 eyes (92.9%). Five eyes received a second dexamethasone implant, generally around 6 months after the first, for persistent or recurrent CME associated with clinically active uveitis. Three eyes developed cataract. Kaplan-Meier analysis estimated first-implant treatment success at 74% between 3 and 6 months and 42% after 9 months.
CONCLUSION: In this selected real-world cohort, dexamethasone implant monotherapy was associated with significant anatomical improvement and early functional improvement, with high 12 month follow-up completeness. The initial implant provided a clinically useful but time-limited treatment effect, and repeat implantation was required in a subset of eyes. These findings support dexamethasone implant as a local treatment strategy for selected patients with uveitic macular edema while emphasizing the need for monitoring of ocular steroid-related adverse effects and individualized long-term inflammatory management.