A new medical trial “strongly indicates” that this is “the most effective therapy” to control inflammation and improve vision in people suffering from Uveitis-related “recurrent macular edema, a major cause of vision loss in people with uveitis.”

Results from a new clinical trial shed light on the promising role of intraocular corticosteroids in managing uveitis-related macular edema, offering renewed hope for patients with chronic inflammatory eye conditions.

Results from a clinical research supported by the National Eye Institute (NEI) showed that repeat therapy with corticosteroid injections restored vision in patients with chronic or recurrent uveitis-related macular edema better than two other regimens.

The corticosteroid treatment reduced retinal edema more effectively than methotrexate or intravitreal (in the eye) injections of ranibizumab, and it was the only medication in the research to enhance vision.

The study was published in the journal Ophthalmology today. NEI operates under the umbrella of the National Institutes of Health.

“Prior to this study,” comments researcher Douglas A. Jabs, “we didn’t know the best treatment for persistent or recurrent macular edema, a major cause of vision loss in people with uveitis.”

“This trial strongly indicates that repeat intraocular corticosteroid injections are superior to either intravitreal injections of methotrexate or ranibizumab.”

Uveitis encompasses an array of inflammatory disorders affecting the eye’s internal structures. The inflammation can occur in various sections of the eye – the anterior (front), intermediate (middle), posterior (back), or spanning across these regions. This inflammation can trigger fluid accumulation in the retina’s central section, known as the macula, leading to compromised vision. This accumulation, termed macular edema, is a common uveitis complication and tends to be chronic or recurring.

The preliminary treatment for uveitis-induced macular edema aims at managing inflammation and lessening fluid in the retinal area. Though oral corticosteroids benefit some, most individuals require intraocular corticosteroid injections as well. The dexamethasone intraocular implant exemplifies one such intervention. However, intraocular corticosteroids can elevate eye pressure. This rise is a significant glaucoma risk factor, potentially harming the optic nerve and causing vision loss. Moreover, these corticosteroids may result in cataracts, clouding the eye’s lens and reducing vision.

In this study, the investigators evaluated three interventions for uveitis-induced macular edema: an additional intraocular corticosteroid injection, ranibizumab (an anti-VEGF drug), or methotrexate (an anti-inflammatory drug). Anti-VEGF injections are typically utilized to address age-related macular degeneration and macular edema from varied causes like diabetic retinopathy. Preliminary smaller studies hinted that ranibizumab and methotrexate’s anti-inflammatory properties could alleviate uveitis-related macular edema.

Involving 194 subjects (225 eyes) with controlled uveitis but chronic or recurring macular edema, the study distributed the participants into three groups: 65 received a dexamethasone corticosteroid, 65 received methotrexate, and 64 received ranibizumab. This multi-center study spanned 33 clinical centers across the US, UK, Australia, and India. All participants had previously undergone at least one intraocular corticosteroid injection for their condition.

Based on general clinical practice, the groups followed different injection schedules. Those in the corticosteroid group received one dexamethasone implant injection initially and, if required, another at eight weeks. The methotrexate group received injections at the beginning, and if needed, further injections at four and eight weeks. The ranibizumab group received injections at the onset, four weeks, and eight weeks.

Following a period of 12 weeks, each of the three groups exhibited decreases in retinal swelling. However, the group that received the dexamethasone corticosteroid noted the highest drop in swelling – a 35% reduction, compared to 20% in the ranibizumab group, and 11% in the methotrexate group. It’s noteworthy that improvement in vision were exclusively observed in the corticosteroid group, with an improvement equating to nearly five letters, or roughly a full row on an eye chart. While there were more instances of mild intraocular pressure increase in the corticosteroid group, the occurrence of significant pressure increases remained relatively low (<10%) across all groups.

“Intraocular corticosteroid treatment remains the most effective therapy for uveitis-related macular edema,” points out lead author Nisha Acharya. “The vision gains in participants who received the corticosteroid treatment were very promising.”

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