Use of Corticosteroid Effective in Treating Patients With Uveitic Macular Edema

A team of researchers have found that dexamethasone—a corticosteroid—improved the vision of patients with persistent or recurrent uveitis-related macular edema.

Macular edema is the most common complication of uveitis and may lead to visual impairment or legal blindness in patients. In their study, researchers aimed to find an effective treatment for this complication by comparing three different intravitreal therapies: (1) dexamethasone implant, (2) methotrexate, and (3) ranibizumab.

The researchers conducted a multicenter, randomized trial that included participants (n = 194; 225 eligible eyes) with minimally active or inactive uveitis and persistent or recurrent uveitic macular edema in one or both eyes. The participants at 33 centers were randomized to receive one of the three treatments for 12 weeks. The primary endpoint was reduction in central subfield thickness (CST) that was expressed as a proportion of baseline.

At 12 weeks, the researchers reported that each group showed significant reductions in CST relative to their baseline. The dexamethasone group had a 35% reduction, while the methotrexate and ranibizumab groups showed an 11% and 22% reduction, respectively. Further, the reduction of macular edema was greater in the dexamethasone group when compared to the other two treatments.

Additionally, elevations of intraocular pressure—a secondary endpoint— by 10 mmHg, to 24 mmHg or more, or both were more common in the dexamethasone group when compared with methotrexate and ranibizumab.

The study had limitations. The researchers noted that the study stopped before achieving their target enrollment amount as the period of enrollment was prolonged. Despite the limitation, the researchers note the strength of their study in the treatment of recurrent or persistent uveitic macular edema.

“Dexamethasone was superior to methotrexate and ranibizumab for the treatment of persistent or recurrent [macular edema] in patients with inactive or minimally active uveitis at 12 weeks” the researchers concluded. “The risk of moderate IOP elevation was greater with dexamethasone, but the occurrence of IOP elevation to the 30-mmHg or more threshold, occurrence of glaucoma, and the need for glaucoma surgery were minimal. These results suggest that intravitreal corticosteroid therapy, unless contraindicated, should be the preferred therapy for this indication.”

Reference:

Acharya NR, Vitale AT, Sugar EA, et al. The Multicenter Uveitis Steroid Treatment Trial (MUST) Research Group, Writing Committee. Intravitreal therapy for uveitic macular edema—ranibizumab versus methotrexate versus the dexamethasone implant. Ophthalmol. June 13, 2023. doi:10.1016/j.ophtha.2023.04.011