Intravitreal Dexamethasone Implants for Non-infectious Uveitis: A Review of Clinical Effectiveness, Cost-effectiveness, and Guidelines

Key Message

Three randomized controlled trials (RCTs), one economic evaluation report and two guideline documents are included in this review. The findings observed in two RCTs indicated that one intravitreal dexamethasone implant (IDI) dose appeared to be a safe and effective option in preventing the complications of uveitic cataract surgery. One RCT suggested that IDI was superior to periocular triamcinolone injection for treating uveitic macular edema with minimal risk of intraocular pressure elevation. However, the findings reported in the three RCTs should be interpreted with caution due to various limitations of the study design. The UK economic report indicated that IDI was cost-effective compared with the limited current practice in the treatment of non-infectious uveitis (NIU). Nevertheless, uncertainty remains due to scarcity of evidence. American Academy of Ophthalmology (AAO) guidance provided the recommendations on the use of non-corticosteroid systemic immunomodulatory treatment in NIU. NICE guideline recommended adalimumab and IDI be options for the treatment of NIU. No recommendation on the IDI dose regimen (i.e., the number of implants and frequency of reinjections) was specified in NICE guideline. Further research needed to address uncertainty on the clinical efficacy and safety, cost-effective as well as the clinical guidelines regarding the use of different dose regimens of IDI in the treatment of NIU.​