Brand Names of Intravitreal Immunosuppressive Drugs
The primary intravitreal immunosuppressive agents available are corticosteroid-based sustained-release implants and injectable formulations, including Ozurdex (dexamethasone), Retisert and Iluvien (fluocinolone acetonide), and Kenalog/Triesence (triamcinolone acetonide). 1, 2
FDA-Approved Sustained-Release Corticosteroid Implants
Ozurdex (dexamethasone intravitreal implant) is a biodegradable sustained-release device approved for posterior uveitis and retinal vascular occlusion with macular edema, offering a better safety profile and slightly longer duration than triamcinolone acetonide 2
Retisert (fluocinolone acetonide implant) is a surgically-placed device that releases corticosteroids at a constant rate for 2.5 years, though it carries very high risks of cataract formation and IOP-lowering surgery requirements 2
Iluvien (fluocinolone acetonide implant) is another sustained-release fluocinolone acetonide device used for chronic inflammatory conditions 1
Injectable Corticosteroid Formulations
Kenalog (triamcinolone acetonide) is the most commonly used intravitreal corticosteroid for uveitis and uveitic macular edema, though it has limited duration of action and high risk of IOP elevation and cataract 2
Triesence (triamcinolone acetonide) is a preservative-free formulation specifically designed for intraocular use 1
Xipere (triamcinolone acetonide) is FDA-approved exclusively for suprachoroidal injection (not intravitreal) as a single 4 mg dose for macular edema associated with uveitis 3
Non-Corticosteroid Intravitreal Immunosuppressants
Intravitreal methotrexate has been extensively studied in noninfectious posterior uveitis and may offer a better alternative for steroid responders, though it remains largely investigational 4, 2
Intravitreal sirolimus demonstrates moderate effectiveness in reducing inflammation with low adverse event rates in active noninfectious uveitis, though evidence is limited (Grade C recommendation) 5, 4
Important Clinical Considerations
All intravitreal corticosteroids are associated with significant local adverse effects including elevated IOP, glaucoma, and cataract formation 5
Triamcinolone acetonide formulations have the highest risk of corticosteroid-induced IOP elevation, while Ozurdex appears to have a more favorable safety profile 2
Most intravitreal corticosteroids have limited duration of action requiring repeated injections, with the exception of the Retisert implant which lasts 2.5 years 1, 2