Incidence and prevalence (all types)1
  • The Northern California Epidemiology of Uveitis Study (N = 731,898) — this was the largest population-based uveitis study in the United States to date, concluding that the incidence of uveitis was approximately 3 times that of previous US estimates and increased with the increasing age of patients
  • Annual incidence of 52.4 per 100,000 person-years and a period prevalence of 115.3 per 100,000 persons
Symptoms of noninfectious uveitis affecting the posterior segment of the eye2
  • Intermediate uveitis—Sudden painless vision loss or vision decrease with appearance of floaters is typical
  • Posterior uveitis—Decrease in vision and floaters are typical. There may also be retinal detachment and optic nerve inflammation
Diagnosis3

In any patient who has floaters, decreased vision, ocular ache, redness, or photophobia, uveitis can be suspected. Diagnosis can be performed via slit-lamp or dilated fundus examination.

  • Intermediate uveitis—A main sign is cells in the vitreous humor and aggregates of inflammatory cells near the junction of the iris and sclera (these cells form the appearance of snowballs over the pars plana, associated with neovascularization of the retinal periphery). Floaters may decrease vision
  • Posterior uveitis—This type of uveitis has varied symptoms, but similar to intermediate uveitis, commonly causes floaters and decreased vision. Signs include the following:
    • Cells inside the vitreous humor
    • White or yellow-white lesions in the retina, underlying choroid, or both
    • Retinal vasculitis
    • Optic disc edema
    • Exudative retinal detachments
Etiology3

Intermediate and posterior uveitis are typically idiopathic in nature.


Potential impact of untreated noninfectious posterior segment uveitis2,3

While many patients have only a single episode of noninfectious posterior segment uveitis, others may have recurrences over months to years. In either situation, untreated uveitis may result in long-term vision-threatening complications.

Fundoscopies Showing Evidence of Uveitis

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Indications and Usage
Retinal Vein Occlusion
OZURDEX® (dexamethasone intravitreal implant) is a corticosteroid indicated for the treatment of macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).

Posterior Segment Uveitis
OZURDEX® is indicated for the treatment of noninfectious uveitis affecting the posterior segment of the eye.

Dosage and Administration
FOR OPHTHALMIC INTRAVITREAL INJECTION ONLY. The intravitreal injection procedure should be carried out under controlled aseptic conditions. Following the intravitreal injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay.

Important Safety Information
Contraindications
Ocular or Periocular Infections: OZURDEX® (dexamethasone intravitreal implant) is contraindicated in patients with active or suspected ocular or periocular infections including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases.

Advanced Glaucoma: OZURDEX® is contraindicated in patients with advanced glaucoma.

Hypersensitivity: OZURDEX® is contraindicated in patients with known hypersensitivity to any components of this product.

Warnings and Precautions
Intravitreal Injection-related Effects: Intravitreal injections have been associated with endophthalmitis, eye inflammation, increased intraocular pressure, and retinal detachments. Patients should be monitored regularly following the injection.

Potential Steroid-related Effects: Use of corticosteroids may produce posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and may enhance the establishment of secondary ocular infections due to bacteria, fungi, or viruses.

Corticosteroids should be used cautiously in patients with a history of ocular herpes simplex.

Risk of Implant Migration: Patients in whom the posterior capsule of the lens is absent or has a tear are at risk of implant migration into the anterior chamber.

Adverse Reactions
The most common ocular adverse reactions reported by greater than 2% of patients in the first 6 months following injection of OZURDEX® for retinal vein occlusion and posterior segment uveitis include: intraocular pressure increased (25%), conjunctival hemorrhage (22%), eye pain (8%), conjunctival hyperemia (7%), ocular hypertension (5%), cataract (5%), vitreous detachment (2%), and headache (4%).

Increased IOP with OZURDEX® peaked at approximately week 8. During the initial treatment period, 1% (3/421) of the patients who received OZURDEX® required surgical procedures for management of elevated IOP.

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References:
  • Gritz DC, Wong IG. Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study. Ophthalmology. 2004;111(3):491-500.
  • The Merck Manuals Online Medical Library website. http://www.merck.com/home/sec20/ch232/ch232a.html. Accessed Sept. 7, 2010.
  • The Merck Manuals Online Medical Library website. Introduction. http://www.merck.com/mmpe/sec09/ch105/ch105a.html. Accessed September 7, 2010.
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