Intravitreal dexamethasone implant as an adjunct weapon for severe and refractory uveitis in Behçet's disease

Objective: To investigate both efficacy and safety of dexamethasone (DEX) implant in the treatment of refractory Behçet’s disease (BD)-related panuveitis or posterior uveitis. Method: A total of 5 eyes from 5 patients with active refractory BD-uveitis were enrolled in the study. A single intravitreal injection of DEX implant was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT) assessed with optical coherence tomography, occurrence of vasculitis assessed by fluorescein angiography, vitreous haze score (Nussenblatt scale), intraocular pressure (IOP), and lens status (LOCS III, Lens Opacities Classification System III) were recorded at baseline and subsequently at each follow-up visit at 1 month, 3 months, and 6 months post-treatment. Results: At baseline, all eyes showed marked macular edema and 4 out of 5 had concomitant active retinal vasculitis. The mean BCVA was increased from baseline at each control visit with a mean improvement at 6-month follow-up of 0.26±0.18 lines. Mean CMT decreased from baseline at each control visit with a mean improvement at 6-month follow-up of 198.80±80.08 µm. At the end of treatment none of the eyes showed signs of macular edema, and the mean CMT was 276.80±24.94 µm. Retinal vasculitis resolved in all affected eyes. One eye experienced an IOP spike (<20 mmHg) during treatment, that resolved spontaneously; one eye developed a clinically significant lens opacity at the 6-month follow-up. Conclusions: The application of DEX implant in refractory BD uveitis and inflammatory macular edema was safe and effective as an additional treatment combined with systemic immunomodulatory drugs.