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Intravitreal Dexamethasone Implant for Treatment of Sarcoidosis-Related Uveitis

Advances in Therapy volume 36, pages 2137–2146 (2019)Cite this article

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Abstract

Purpose

To assess the efficacy and safety of intravitreal dexamethasone implant injection in the management of sarcoidosis-related uveitis.

Methods

A retrospective analysis was performed of the efficacy and safety of intravitreal dexamethasone implant injection for indications such as intractable vitritis, vasculitis, or cystoid macular edema.

Results

This study comprised 20 patients with sarcoidosis-related uveitis. A single injection was performed in 13 eyes (65%) and 35% required more than 2 injections during the follow-up period [median 16.5 months (range 6–32)]. The best-corrected visual acuity showed significant improvement at 1 month (P = 0.004) and 3 months (P = 0.001), but there was no significance at 6 months after implant injection (P = 0.186). One month after treatment, the central macular thickness decreased to 278.95 ± 52.20 μm (P = 0.023). It further decreased to 274.70 ± 55.88 μm at 3 months (P = 0.027), but there was no significance at 6 months (280.65 ± 64.48 μm, P = 0.074).The anterior chamber cell grade (P = 0.003) and vitreous haze (P = 0.001) were significantly decreased for up to 6 months after a single implant injection. The most common ocular complication was worsening of cataracts during the first 6 months.

Conclusion

Intravitreal dexamethasone implant injection is efficacious in reducing anterior chamber inflammation, vitreous haze, and cystoid macular edema in patients with sarcoidosis-related uveitis. Considering that sarcoidosis shows a chronic course of disease in a significant proportion of cases, intravitreal dexamethasone implant injection is a possible option to relieve intraocular inflammation.

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References

  1. Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med. 1997;336:1224–34. https://doi.org/10.1056/nejm199704243361706.

    Article  CAS  PubMed  Google Scholar 

  2. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee. 1999. Am J Respir Crit Care Med 160: 736–755. https://doi.org/10.1164/ajrccm.160.2.ats4-99.

  3. Herbort CP, Rao NA, Mochizuki M. International criteria for the diagnosis of ocular sarcoidosis: results of the first International Workshop On Ocular Sarcoidosis (IWOS). Ocul Immunol Inflamm. 2009;17:160–9. https://doi.org/10.1080/09273940902818861.

    Article  CAS  PubMed  Google Scholar 

  4. Jamilloux Y, Kodjikian L, Broussolle C, Seve P. Sarcoidosis and uveitis. Autoimmun Rev. 2014;13:840–9. https://doi.org/10.1016/j.autrev.2014.04.001.

    Article  PubMed  Google Scholar 

  5. Ma SP, Rogers SL, Hall AJ, Hodgson L, Brennan J, Stawell RJ, Lim LL. Sarcoidosis-related uveitis: clinical presentation, disease course, and rates of systemic disease progression after uveitis diagnosis. Am J Ophthalmol. 2019;198:30–6. https://doi.org/10.1016/j.ajo.2018.09.013.

    Article  PubMed  Google Scholar 

  6. Rothova A, Alberts C, Glasius E, Kijlstra A, Buitenhuis HJ, Breebaart AC. Risk factors for ocular sarcoidosis. Doc Ophthalmol. 1989;72:287–96.

    Article  CAS  PubMed  Google Scholar 

  7. Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H Jr, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R. Clinical characteristics of patients in a case control study of sarcoidosis. Am J Respir Crit Care Med. 2001;164:1885–9. https://doi.org/10.1164/ajrccm.164.10.2104046.

    Article  CAS  PubMed  Google Scholar 

  8. Matsou A, Tsaousis KT. Management of chronic ocular sarcoidosis: challenges and solutions. Clin Ophthalmol. 2018;12:519–32. https://doi.org/10.2147/opth.s128949.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Riancho-Zarrabeitia L, Calvo-Rio V, Blanco R, Mesquida M, Adan AM, Herreras JM, Aparicio A, Peiteado-Lopez D, Cordero-Coma M, Garcia Serrano JL, Ortego-Centeno N, Maiz O, Blanco A, Sanchez-Burson J, Gonzalez-Suarez S, Fonollosa A, Santos-Gomez M, Gonzalez-Vela C, Loricera J, Pina T, Gonzalez-Gay MA. Anti-TNF-alpha therapy in refractory uveitis associated with sarcoidosis: multicenter study of 17 patients. Semin Arthritis Rheum. 2015;45:361–8. https://doi.org/10.1016/j.semarthrit.2015.05.010.

    Article  CAS  PubMed  Google Scholar 

  10. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153–65. https://doi.org/10.1056/NEJMra071714.

    Article  CAS  PubMed  Google Scholar 

  11. Cottin V. Update on bioagent therapy in sarcoidosis. F1000 medicine reports, 2, 13. 2010. https://doi.org/10.3410/m2-13. Accessed 8 Aug 2019.

  12. Myung JS, Aaker GD, Kiss S. Treatment of noninfectious posterior uveitis with dexamethasone intravitreal implant. Clin Ophthalmol. 2010;4:1423–6. https://doi.org/10.2147/opth.s15696.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zarranz-Ventura J, Carreno E, Johnston RL, Mohammed Q, Ross AH, Barker C, Fonollosa A, Artaraz J, Pelegrin L, Adan A, Lee RW, Dick AD, Sallam A. Multicenter study of intravitreal dexamethasone implant in noninfectious uveitis: indications, outcomes, and reinjection frequency. Am J Ophthalmol. 2014;158:1136–1145.e1135. https://doi.org/10.1016/j.ajo.2014.09.003.

    Article  CAS  PubMed  Google Scholar 

  14. Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509–16.

    Article  PubMed  Google Scholar 

  15. Lowder C, Belfort R Jr, Lightman S, Foster CS, Robinson MR, Schiffman RM, Li X-Y, Cui H, Whitcup SM, Group OHS. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011;129:545–53. https://doi.org/10.1001/archophthalmol.2010.339.

    Article  PubMed  Google Scholar 

  16. Stanbury RM, Graham EM. Systemic corticosteroid therapy–side effects and their management. Br J Ophthalmol. 1998;82:704–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Buchman AL. Side effects of corticosteroid therapy. J Clin Gastroenterol. 2001;33:289–94.

    Article  CAS  Google Scholar 

  18. Tomkins-Netzer O, Taylor SR, Bar A, Lula A, Yaganti S, Talat L, Lightman S. Treatment with repeat dexamethasone implants results in long-term disease control in eyes with noninfectious uveitis. Ophthalmology. 2014;121:1649–54. https://doi.org/10.1016/j.ophtha.2014.02.003.

    Article  PubMed  Google Scholar 

  19. Haller JA, Bandello F, Belfort R Jr, Blumenkranz MS, Gillies M, Heier J, Loewenstein A, Yoon YH, Jacques ML, Jiao J, Li XY, Whitcup SM. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117:1134–1146.e1133. https://doi.org/10.1016/j.ophtha.2010.03.032.

    Article  PubMed  Google Scholar 

  20. Haller JA, Bandello F, Belfort R Jr, Blumenkranz MS, Gillies M, Heier J, Loewenstein A, Yoon YH, Jiao J, Li XY, Whitcup SM, Li J. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology. 2011;118:2453–60. https://doi.org/10.1016/j.ophtha.2011.05.014.

    Article  PubMed  Google Scholar 

  21. Moisseiev E, Goldstein M, Waisbourd M, Barak A, Loewenstein A. Long-term evaluation of patients treated with dexamethasone intravitreal implant for macular edema due to retinal vein occlusion. Eye (Lond). 2013;27:65–71. https://doi.org/10.1038/eye.2012.226.

    Article  CAS  Google Scholar 

  22. Calvo P, Ferreras A, Al Adel F, Dangboon W, Brent MH. Effect of an intravitreal dexamethasone implant on diabetic macular edema after cataract surgery. Retina. 2018;38:490–6. https://doi.org/10.1097/iae.0000000000001552.

    Article  CAS  PubMed  Google Scholar 

  23. Malcles A, Dot C, Voirin N, Agard E, Vie AL, Bellocq D, Denis P, Kodjikian L. Real-life study in diabetic macular edema treated with dexamethasone implant: the Reldex Study. Retina. 2017;37:753–60. https://doi.org/10.1097/iae.0000000000001234.

    Article  CAS  PubMed  Google Scholar 

  24. Malcles A, Dot C, Voirin N, Vie AL, Agard E, Bellocq D, Denis P, Kodjikian L, Safety of Intravitreal Dexamethasone Implant (Ozurdex): The SAFODEX study. Incidence and risk factors of ocular hypertension. Retina. 2017;37:1352–9. https://doi.org/10.1097/iae.0000000000001369.

    Article  CAS  PubMed  Google Scholar 

  25. Kiddee W, Trope GE, Sheng L, Beltran-Agullo L, Smith M, Strungaru MH, Baath J, Buys YM. Intraocular pressure monitoring post intravitreal steroids: a systematic review. Surv Ophthalmol. 2013;58:291–310. https://doi.org/10.1016/j.survophthal.2012.08.003.

    Article  PubMed  Google Scholar 

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Acknowledgements

Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2016R1A6A1A03010528). Article processing charges were funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Mirinae Kim, Seong Ah Kim, Wookyung Park, Rae Young Kim, and Young-Hoon Park have nothing to declare.

Compliance with Ethics Guidelines

This study adhered to the tenets of the Declaration of Helsinki, and all protocols were approved by the Institutional Review Board of The Catholic University of Korea. The requirement for informed patient consent was waived because of the retrospective nature of the study.

Data Availability

The datasets analyzed for the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Mirinae Kim, Seong Ah Kim, Wookyung Park, Rae Young Kim & Young-Hoon Park

  2. Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Young-Hoon Park

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  1. Mirinae Kim
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  2. Seong Ah Kim
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Correspondence to Young-Hoon Park.

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Kim, M., Kim, S.A., Park, W. et al. Intravitreal Dexamethasone Implant for Treatment of Sarcoidosis-Related Uveitis. Adv Ther 36, 2137–2146 (2019). https://doi.org/10.1007/s12325-019-00989-4

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  • DOI: https://doi.org/10.1007/s12325-019-00989-4

Keywords

  • Intravitreal dexamethasone implant
  • Ophthalmology
  • Ozurdex
  • Sarcoidosis
  • Uveitis