Uveitis is a collection of inflammatory conditions that affect the internal tissues of the eye. Uveitis can affect the front of the eye (anterior uveitis), the middle of the eye (intermediate uveitis), the back of the eye (posterior uveitis), or the front, middle, and back of the eye (panuveitis). Inflammation in the eye can lead to fluid buildup in the central part of the eye’s light-sensing retina, known as the macula, and decrease vision. This fluid buildup, called macular edema, is a complication of uveitis that often persists or recurs over time, despite uveitis treatment.
Initial treatment for uveitis-related macular edema seeks to control inflammation and reduce the fluid under the retina. While some patients achieve this goal with oral corticosteroids, most patients with macular edema also need intraocular corticosteroid injections. The dexamethasone intraocular implant is one such treatment. However, intraocular corticosteroids can raise pressure inside the eye. High intraocular pressure is a key risk factor for glaucoma, which can damage the optic nerve and lead to vision loss. Intraocular corticosteroids can also lead to cataract, a clouding of the eye’s lens, which decreases vision.
The injection schedules for each group were based on how each treatment is generally used in clinical practice. The corticosteroid group participants received one dexamethasone implant injection at baseline and, if the macular edema had not resolved, another injection at eight weeks. The methotrexate group received one injection at baseline, then repeat injections at four and eight weeks if macular edema did not resolve. The ranibizumab group received injections at baseline, four weeks, and eight weeks, even if their macular edema resolved.
After 12 weeks, all three groups showed reductions in retinal swelling. Reduction was greatest in the dexamethasone group compared to the other two (35% reduction for corticosteroid; 20% for ranibizumab; 11% for methotrexate). In addition, only the corticosteroid group showed improvement in vision, nearly five letters—about one row on an eye chart. The corticosteroid group did have more occurrences of mild increases in intraocular pressure, but rises to high levels were infrequent (
This study was funded by NEI. Allergan and Genentech provided a portion of the dexamethasone implants and ranibizumab, respectively. Clinical Trial number NCT02623426.
NEI leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs to develop sight-saving treatments and address special needs of people with vision loss. For more information, visit https://www.nei.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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Reference
The Multicenter Uveitis Steroid Treatment Trial (MUST) Research Group. “Intravitreal therapy for uveitic macular edema – ranibizumab vs methotrexate vs the dexamethasone implant: The MERIT Trial Results.” Ophthalmology, June 13, 2023.
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