What effects do repeated Ozurdex implants have in paediatric uveitis?
Reviewed by Efrosini Papagiannuli

The aim of this retrospective study was to assess the anatomical and functional results, as well as complications of repeated Ozurdex intravitreal implants in a paediatric (non-infectious) uveitis cohort. Twenty-two eyes (16 patients) received 35 Ozurdex implants over a six year period. Fourteen eyes had intermediate and eight eyes posterior uveitis or panuveitis. The aetiology in 15 eyes was idiopathic, pars planitis in three eyes, juvenile idiopathic arthritis in two eyes and Vogt-Konyanagi-Harada disease in two eyes. The average patient age at the time of the first implant was 13 +/- 0.7 years, nine patients were on treatment with systemic steroids and 11 patients had previously been treated with immunosuppressants (eight with mycophenolate mofetil, three infliximab, two azathioprine, two methotrexate,one cyclosporin). Of these 11 patients, four were still on immunosuppressants (three mycophenolate mofetil, one infliximab). There were four eyes that had previous orbital floor steroid injections and eight eyes that had received intravitreal Triamcinolone. The Ozurdex injections were performed under general anaesthesia, in patients who had previously responded well to a periocular steroid injection, could not tolerate systemic treatment, or low does systemic treatment was ineffective. There was cystoid macular oedema (CMO) in 77.3% and vitritis in 22.3%. Outcome measures included visual acuity (BCVA), central retinal thickness (CRT), systemic immunosuppression (number and dosage of drugs), vitreous haze score, and presence of cataract or elevated intraocular pressure (IOP>21 mmHg). Data was collected on the day of implantation, months one, two, three, six, 12, 18, 24 and last follow-up. The results were encouraging, as after the first implantation the BCVA improved significantly from 0.55 +/-0.08 to 0.37+/-0.08 LogMAR (p=0.024), CRT decreased by 219+/- 55 microns (p=0.01) and a vitreous haze score of 0 was achieved in 88% of eyes (up from 41%, p=006). Average follow-up time was 16.1+/-2.1 months after the first implant. Thirteen eyes (59.1%) received only one Ozurdex implant and nine eyes (40.9%) required multiple implants. The median time to relapse was nine months and all children who were using systemic immunosuppression could either stop it or decrease both the number of drugs used and their dose. The average time to restarting systemic treatment was 16.1+/-2.5 months. In terms of side-effects, there were six eyes with an increase in IOP, of which five responded to pharmacological treatment and one required revision of a previous glaucoma procedure. There were also four eyes with a visually insignificant lens opacity that did not require any intervention. No endophthalmitis, retinal detachment or implant migration was reported. The authors conclude that despite the need for general anaesthesia, Ozurdex implants are a valuable option in treatment resistant paediatric uveitis with an acceptable side-effect profile. They advocate close monitoring of these patients as they are at risk of amblyopia due to lens opacities and recommend prompt surgical treatment when visually significant cataracts develop, in order to preserve visual function. They highlight the limitations of their study in terms of study design (retrospective) and small patient numbers and recommend further studies to examine the possible development of longer-term complications. 

Outcome of treating pediatric uveitis with dexamethasone implants.
Tomkins-Netzer O, Talat L, Greenstein SS, et al.
AMERICAN JOURNAL OF OPHTHALMOLOGY
2016;161:110-5.