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Corticosteroid — Intravitreal Biodegradable Implant Pregnancy: Avoid — corticosteroids affect fetal development

Dexamethasone Intravitreal Implant 0.7 mg

Brand names: Ozurdex

Adult dose

Dose: 0.7 mg intravitreal implant (single applicator injection)
Route: Intravitreal implant (single injection via 22-gauge applicator)
Frequency: One implant; can be repeated no sooner than 3–6 months if response maintained
Max: One implant per eye; bilateral treatment requires two separate implants
Biodegradable poly(D,L-lactide-co-glycolide) (PLGA) polymer matrix — releases dexamethasone over 3–6 months then biodegrades; no removal required. Licensed for: macular oedema secondary to BRVO/CRVO, posterior non-infectious uveitis, and DME in pseudophakic eyes.

Paediatric dose

Route:
Not licensed for paediatric use — seek specialist opinion

Dose adjustments

Renal

No systemic dose adjustment — intravitreal

Hepatic

No adjustment

Clinical pearls

  • Biodegradable implant advantage: unlike triamcinolone injection (which requires repeat injections every 3–4 months), Ozurdex releases dexamethasone gradually over 3–6 months then biodegrades — no removal required; smooth drug release curve
  • IOP monitoring is MANDATORY: IOP elevation occurs in ~33% within 8 weeks — patients must be seen at week 8 post-injection; if IOP >25 mmHg, start topical IOP-lowering agents; if uncontrolled, implant may need to be removed (rare)
  • Phakic eyes and cataract: posterior subcapsular cataract is expected with repeated treatment in phakic eyes — MHRA and NICE recommend preferential use in pseudophakic eyes for DME; discuss cataract development in consent for phakic patients
  • NICE TA349: Ozurdex approved for macular oedema secondary to BRVO and CRVO; TA229 for posterior non-infectious uveitis; TA409 for DME (pseudophakic or unsuitable for laser)
  • Ruptured posterior capsule contraindication: if posterior lens capsule is torn (post-cataract surgery complication), the implant can migrate through into the anterior chamber — this would cause corneal decompensation; screen surgical history before injection

Contraindications

  • Active ocular or periocular infection
  • Glaucoma with cup-to-disc ratio >0.8 or poorly controlled IOP
  • Torn or ruptured posterior lens capsule (risk of forward migration into anterior chamber)
  • Hypersensitivity to dexamethasone or excipients

Side effects

  • IOP elevation — in 33% at any time point; peaks at 8 weeks post-injection
  • Posterior subcapsular cataract — occurs in phakic eyes; informed consent essential
  • Conjunctival haemorrhage (injection-related)
  • Vitreous detachment
  • Endophthalmitis (rare)

Interactions

  • No clinically significant systemic drug interactions

Monitoring

  • IOP at week 8 post-injection (mandatory)
  • IOP monthly for first 3 months
  • OCT — central retinal thickness
  • Lens status (cataract formation in phakic eyes)
  • Visual acuity

Reference: BNFc; BNF 90; NICE TA229; NICE TA349; NICE TA409; MACULAR Trial; SPC Ozurdex. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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