Local steroidal treatments: what's new

SummaryLocal Steroidal TreatmentsSevere vision loss occurs in 25%‐33% of all uveitis cases. Repeated bouts of inflammation increase risk of severe vision loss.Local Treatment Options Periocular steroids Intravitreal steroids Intravitreal drug delivery Dexamethasone 700 ug implant (Ozurdex) up to 6 months – short term therapy Fluocinolone acetonide 0.59 mg implant (Retisert) up to 36 months – long term therapy Undergoing Clinical Trial Fluocinolone acetonice 0.19 mg implant (Psivida) up to 36 months – long term therapy How to choose the appropriate treatment? If there is systemic disease that requires anti‐inflammatory therapy, maximize immunomodulatory therapy (IMT) rather than treating both locally and systemically for extended periods of time “Breakthrough” cystoid macular edema in disease otherwise controlled with IMT may benefit from local therapy with Ozurdex, posterior subtenon Kenalog, intravitreal triesence or VEGF inhibition. Disease that needs short term treatment should not be treated with long lasting implant (fluocinolone acetonide). Disease likely to need many years of treatment should not be given repeated short lasting implant (dexamethasone) or intravitreal triamcinolone injections.