Intravitreal injections are becoming a popular method for delivering drugs to treat posterior eye diseases like uveitis. While topical eye drops have low bioavailability, intravitreal injections directly inject medications into the eye, allowing therapeutic doses to reach the posterior segment. Common drugs administered via intravitreal injection include steroids like triamcinolone to control inflammation, as well as antibiotics and antivirals to treat conditions like endophthalmitis. Potential complications include increased intraocular pressure from steroids or macular infarction from antibiotics, but intravitreal injections can help treat uveitis when other methods are ineffective or to avoid systemic side effects of oral medications.

1. Intravitreal drugs in uveitis
Dr. Gehad El Nahri Unit
Ophthalmology department

2.  Prepared by:
Asmaa Ezz
Under supervision
of:
Dr/ Maha Youssef

3. Outline
Different types of uveitis2
Drugs’ delivery methods3
Value of intravitreal
injection4
1
5 Indications
6
7
8
How to give intravitreal
injections
Common drugs used in
treatment of uveitis
Complications
Uveitis

4. Uveitis
 Uveitis is a general term
describing a group of
inflammatory diseases that
affect the uvea.
 These diseases can slightly
reduce vision or lead to
severe vision loss.
1

5. Different types of Uveitis
Iris &
anterior
ciliary
body
Posterior
ciliary
body& the
vitreous
Choroid &
associated
retina
Anterior
Uveitis
Intermediate
Uveitis
Posterior
Uveitis
2
Panuveitis

6. Drugs’ delivery methods
 The most common drug delivery
method for treating ocular disorders
is topical administration.
3
 Unfortunately, topically
administered treatments are
rapidly drained from the ocular
surface, resulting in less than 5%
bioavailability, mainly to the
anterior segment of the eye.

7. Value of intravitreal injection
 Due to the barriers present,
currently there is no eye drops
approved for treating posterior eye
diseases.
 An intravitreal injection is a
shot of medicine into the eye.
 Intravitreal injections are
becoming popular.
4

8. Indications5
Endophthalmitis :
Bacterial e.g. Staph. aureus, Pseudomonas.
Fungal e.g. Candida, Asperigellus.
 Posterior uveitis not responding to
posterior sub-tenon injection.
 Alternative to systemic drugs as they are able to avoid
systemic side effects but achieve a therapeutic dose.
 Viral uveitis e.g. CMV.

9. How to give intravitreal injection?6

10. Common drugs used in treatment of uveitis
 The goals of therapy in
uveitis are to control
inflammation, minimize
recurrences, and prevent the
complications secondary to
the disease or the therapy
itself.
7

11. Antibiotics
Antiviral
Antifungal
Steroids
1. Amphotericin B 5 micrograms/0.1ml
2. Voriconazole 50-100 micrograms/0.1
ml
Triamcinolone 0.1cc of 4mg/m
Cidofovir- 20 micrograms
1. Vancomycin 1mg/0.1ml
2. Ceftazidime 2.25mg/0.1ml
3. Amikacin 0.4mg/0.1ml

12. Complications
K
S
 There are
complications related
to the procedure itself
and others related to
the drugs used.
8

13. Complications related to the procedure
 Retinal
detachment
 Subconjuctival
hemorrhage

14. Vitreous
hemorrhage
 Increased IOP

15.  Amikacin
Aminoglycoside antibiotic
Macular infarction.
Complications related to the drugs

16.  Triamcinolone
Steroid
Endophthalmitis,
glaucoma.

17. Do you have
any questions?
??

18. References
1. Durrani, K., et al. "Systemic therapy with conventional and novel immunomodulatory agents for ocular
inflammatory disease." Survey of Ophthalmology 56.6 (2011): 474-510.
2. Multicenter Uveitis Steroid Treatment Trial Research Group. Kempen JH, Altaweel MM, et al. Benefits of systemic
anti-inflammatory therapy versus fluocinolone acetonide intraocular implant for intermediate uveitis, posterior
uveitis, and panuveitis: fifty-four-month results of the multicenter uveitis steroid treatment (MUST) trial and
follow-up study. Ophthalmology. 2015;122(10):1967–1975.
3. Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL. Treatment of posterior uveitis with a
fluocinolone acetonide implant: three-year clinical trial results. Arch Ophthalmol. 2008;126(9):1191–1201.
4. Benitah NR, Sobrin L, Papaliodis GN. The use of biologic agents in the treatment of ocular
manifestations of Behcet’s disease. Semin Ophthalmol. 2011;26:295–303
5. Lowder C, Belfort R, Jr, Lightman S, et al. Dexamethasone intravitreal implant for noninfectious
intermediate or posterior uveitis. Arch Ophthalmol. 2011;129:545–53.
6. Khairallah M, Kahloun R, Ben Yahia S, Jelliti B, Messaoud R. New infectious etiologies for posterior uveitis.
Ophthalmic research. 2013;49(2):66–72.
7. Accorinti M, Gilardi M, Pirraglia MP, et al. Cytomegalovirus anterior uveitis: long-term follow-up of
immunocompetent patients. Graefe’s archive for clinical and experimental ophthalmology = Albrecht von
Graefes Archiv fur klinische und experimentelle Ophthalmologie. 2014 Nov;252(11):1817–1824