University of Illinois, Department of Ophthalmology, Chicago, IL 60612, USA.
Expert Opin Pharmacother. 2011 May;12(7):1127-31. doi: 10.1517/14656566.2011.571209. Epub 2011 Apr 2.
Corticosteroids, administered systemically and periocularly, have long been used to treat intermediate and posterior segment noninfectious uveitis. In addition to systemic immunosuppressive medications, these therapies are used to reduce inflammation, prevent structural complications and prevent long-term visual loss in patients with uveitis. While systemic immunosuppressive therapies carry their own set of side effects, treatment with local steroids is associated with the risk of development of cataract and glaucoma.
Intravitreal delivery of fluocinolone acetonide via a sustained-release implant (Retisert) was approved by the FDA in 2005 for the treatment of noninfectious intermediate and posterior uveitis. Recently, the FDA also approved the biodegradable dexamethasone implant (Ozurdex) for the treatment of noninfectious uveitis involving the posterior segment.
The single injection, 26-week data indicate that the implant is well tolerated and produces meaningful improvements in intraocular inflammation and visual acuity that persist through 6 months. The available 6-month data also indicate that this implant confers much less of a risk of ocular hypertension than other forms of intraocular steroid therapy. However, future longer-term trials are needed to evaluate the efficacy and safety data in patients who receive multiple injections. The newly approved dexamethasone implant, Ozurdex, is a useful addition to our local armamentarium in the treatment of noninfectious intermediate and posterior uveitis given its efficacy, safety, and ease of use in the outpatient setting.
皮质类固醇，通过全身和眼周给药，长期以来一直用于治疗中间和后段非传染性葡萄膜炎。除了全身免疫抑制药物外，这些治疗方法还用于减轻炎症、预防结构并发症，并预防葡萄膜炎患者的长期视力丧失。虽然全身免疫抑制疗法有其自身的副作用，但局部类固醇治疗与白内障和青光眼发展的风险有关。
2005 年，FDA 批准了氟轻松醋酸酯的玻璃体腔内缓释植入物（Retisert）用于治疗非传染性中间和后段葡萄膜炎。最近，FDA 还批准了可生物降解的地塞米松植入物（Ozurdex）用于治疗涉及后段的非传染性葡萄膜炎。
单次注射、26 周的数据表明，该植入物耐受性良好，可显著改善眼内炎症和视力，持续至 6 个月。现有的 6 个月数据还表明，与其他形式的眼内类固醇治疗相比，这种植入物对视神经高压的风险要小得多。然而，需要未来更长时间的试验来评估接受多次注射的患者的疗效和安全性数据。新批准的地塞米松植入物Ozurdex，由于其疗效、安全性和在门诊环境中的易用性，是我们在治疗非传染性中间和后段葡萄膜炎的局部武器库中的一个有用补充。
