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Local therapies useful for treating uveitis

Issue: February 25, 2018

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Thomas A. Albini

WAILEA, Hawaii — Appropriate local therapy can work as well as systemic therapy for treatment of uveitis, according to a speaker.

“So much of uveitis happens in the draining lymph nodes and doesn’t happen in the eye,” Thomas A. Albini, MD, said at Retina 2018, which is a reason why uveitis specialists prefer systemic therapy.

However, beyond oral steroids, there are regional treatments: topical, sub-Tenon’s, intravitreal and sustained release.

Citing a study by Feiler et al. that evaluated short-term safety and efficacy of topical difluprednate for treatment of noninfectious uveitic cystoid macular edema, Albini said that “about 40% of patients with cystoid uveitic macular edema treated with Durezol alone had complete resolution of the uveitic cystoid macular edema, showing ... an impressive posterior segment effect from a topical drop.”

In general, retina specialists prefer intravitreal injections over sub-Tenon’s injections, “but [sub-Tenon’s steroid injections] are very effective in controlling anterior segment inflammation and controlling cystoid macular edema,” Albini said.

Regarding intravitreal steroids, there are “two major players,” according to Albini, Kenalog (triamcinolone, Bristol-Myers Squibb), whose intravitreal use is off-label, and Triescence (triamcinolone, Alcon), which is similar but preservative-free.

These are effective treatments but the effects are short-lived, which is where intravitreal sustained-release dexamethasone comes in, he said. These steroids have about a 4- to 6-month half-life, he said.

Shorter-acting agents are better for acute disease, whereas longer acting agents are better for chronic or recurring disease, according to Albini. Local therapies are, however, still largely limited by local side effects. – by Patricia Nale, ELS

Reference s:

Albini TA. Local vs. systemic treatment in uveitis. Presented at: Retina 2018; Jan. 14-19, 2018; Wailea, Hawaii.

Feiler DL, et al. Retina. 2017;doi: 10.1097/IAE.0000000000001243.

Disclosure: Albini reports he is a consultant/advisor for AbbVie, Bausch + Lomb, Clearside, Genentech, Allergan, pSivida, Santen and Mallinckrodt.