Clinical Scorecard: An Update on Local Steroids for Uveitis

At a Glance

Key Highlights

• Retisert implant (0.59 mg fluocinolone acetonide) provides sustained steroid release for ~30 months but will be discontinued in April 2026.
• Triesence (preservative-free triamcinolone acetonide injectable suspension) was relaunched in 2024 with a significant price increase after supply chain stabilization.
• Yutiq (0.18 mg fluocinolone acetonide implant) approved for up to 36 months of steroid release; Iluvien label expanded to include chronic noninfectious posterior uveitis.

Guideline-Based Recommendations

Diagnosis

• Identify chronic noninfectious posterior uveitis and other intraocular inflammatory conditions unresponsive to topical steroids.

Management

• Consider local steroid implants (Retisert, Yutiq, Iluvien) or injectable steroids (Triesence, Ozurdex) for intraocular inflammation control.
• Use Retisert especially in cases refractory to systemic immunosuppression or when systemic therapy is contraindicated.
• Adjust treatment plans due to Retisert discontinuation by switching to alternative implants or systemic therapies.

Monitoring & Follow-up

• Monitor for cataract formation, intraocular pressure elevation requiring medication, and potential need for glaucoma surgery, especially with Retisert.
• Assess treatment efficacy by reduction in uveitis recurrences and decreased systemic immunosuppression reliance.

Risks

• High incidence of cataracts and elevated intraocular pressure with Retisert implant.
• Potential intraocular toxicity with preservative-containing steroids like Kenalog-40.
• Cost considerations with newer formulations such as Triesence due to significant price increases.

Patient & Prescribing Data

Patients with chronic noninfectious posterior uveitis and other ocular inflammatory conditions requiring local steroid therapy.

Local steroid implants reduce uveitis recurrences and systemic immunosuppression needs but carry risks of cataracts and glaucoma; preservative-free formulations preferred to minimize toxicity.

Clinical Best Practices

• Select local steroid therapy based on disease severity, patient tolerance to systemic immunosuppression, and implant availability.
• Monitor patients closely for ocular side effects including cataract and intraocular pressure elevation.
• Be aware of supply chain and cost issues impacting availability of specific steroid implants and injections.
• Use preservative-free formulations like Triesence when intraoperative visualization and reduced toxicity are priorities.

References

• FDA Approval of Retisert
• MUST Trial Outcomes
• FDA Approval of Yutiq
• Triesence Product Information