Suprachoroidal Delivery of Corticosteroid Slow-Release Implants for the Treatment of Cystoid Macular Edema

Introduction

While intravitreal corticosteroid slow-release implants (CSRIs) like dexamethasone (Ozurdex, Abbvie, North Chicago, Illinois, USA) and fluocinolone (Iluvien, Alpharetta, Georgia, USA) have revolutionized cystoid macular edema (CME) management [1], [2], anterior migration of implants poses risks of endothelial damage, necessitating posterior lamellar keratoplasty [3]. To date, there have been few treatment alternatives as effective or long-lasting as CSRIs for patients with a disrupted iris–lens diaphragm. Scleral fixation of CSRIs with sutures has become a good alternative, particularly for the fluocinolone implant, but this technique can be complex [4]. However, as the fluocinolone implant has a firm non-dissolving shell, scleral fixation is stable in the long term. Scleral fixation of the dexamethasone implant [5], [6] is hardly feasible as the implant loses diameter during drug release, which makes the suture fixation around the implant too loose and dislocation of the implant likely. As cost coverage issues are less problematic with the dexamethasone implant than with the fluocinolone implant and the dexamethasone implant has stronger drug efficacy, an alternative form of application in eyes with a disrupted iris–lens diaphragm that does not require intravitreal delivery by scleral suturing would be desirable. In these cases, suprachoroidal placement of CSRI implants could provide a promising alternative, ensuring stable positioning and effective drug delivery.

Publication History

Received: 31 December 2024

Accepted: 16 January 2025

Accepted Manuscript online:
17 February 2025

Article published online:
16 June 2025

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