Published online Aug 12, 2015. doi: 10.5318/wjo.v5.i3.125
Peer-review started: February 26, 2015
First decision: April 10, 2015
Revised: May 26, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 12, 2015
Intravitreal treatment became popular with the discovery of the blood ocular barriers, which significantly limit drug penetration in systemic or topical administration. As the mainstay of treatment in noninfectious uveitis (NOIU) is still corticosteroids, triamcinolone acetonide (TA) was the first intravitreally used agent in this subset of patients. Although it was very effective in controlling inflammation and improving the inflammation related complications, TA was found to have a high rate of intraocular complications and a relatively short half-life necessitating frequent reinjections. Other systemically used therapeutic options such as methotrexate and anti-tumor necrosis factor-α agents were also tried intravitreally. Additionally anti-vascular endothelial growth factor agents that are widely used intravitreally in the management of diabetic retinopathy and age related macular degeneration have become an option to control the uveitis related complications like macular edema, retinal and choroidal neovascularizations. Advances in biotechnology led to the slow release biodegradable implant era. These implants have a longer duration of action, which may help in decreasing the number of reinjections. Today two forms of implants have been approved for use in NOIU, Retisert (0.59 mg flucinolone acetonide, surgical intervention) and Ozurdex (0.7 mg dexamethasone, office based intervention). Studies dealing with newer agents (cyclosporine, LFG31, sirolimus) in the management of chronic NOIU are on the way. The search for ideal effective, safe and biocompatible intravitreal agents in the management of NOIU has not ended yet.
Core tip: The limitations related to the systemic use of treatment options in noninfectious posterior uveitis yielded intravitreal route. The hallmark of intravitreal treatment triamcinolone acetonide has a short half-life with a high rate of intraocular complications, and this led to the development of implants as a treatment option with various agents in the market still under investigation. In this review, we try to summarize the intravitreal therapeutic options that are being used in noninfectious uveitis.