The use of intraocular corticosteroids.
BACKGROUND
Diabetic macular edema (DME), cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO) and uveitis are responsible for severe visual impairment worldwide. In some patients with these conditions, treatment with intraocular corticosteroids may be beneficial. Although off-label use of these agents has occurred for many years, novel agents including preservative-free and sustained-release intravitreal implants are currently being studied in clinical trials (CTs).


OBJECTIVE
To review the use of intraocular corticosteroids.


METHODS
Literature review.


RESULTS
Used alone, intravitreal corticosteroids may benefit disorders such as DME, RVO and uveitis compared with standard therapy or observation. Patients with AMD may benefit more from combination treatment with photodynamic therapy, intravitreal corticosteroid and intravitreal anti-VEGF injections. Intraoperative use of these agents may assist in visualization and manipulation of fine retinal structures. Sustained-release intraocular implants have been approved for severe posterior uveitis, and have shown benefits in ongoing CTs.


CONCLUSIONS
Although intraocular corticosteroid injections have a limited duration of action requiring frequent re-treatment, and significant side effects including cataract and glaucoma development, intraocular injections may be of benefit in certain ocular disorders. Corticosteroid implants are emerging as potential treatments for macular edema due to uveitis, DME or RVO.
Kiernan
Daniel F
DF
Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Illinois 60612, USA.
Mieler
William F
WF
D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004343:Drug Implants; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008268:Macular Degeneration / Q000188:drug therapy; D012170:Retinal Vein Occlusion / Q000188:drug therapy; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D014605:Uveitis / Q000188:drug therapy; D014822:Vitreous Body / Q000378:metabolism
D000893:Anti-Inflammatory Agents; D004343:Drug Implants; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide