Efficacy and Safety of Fluocinolone Acetonide 0.19 mg Intravitreal Implant for the Treatment of Non-Infectious Uveitis: A Systematic Review of Real-World Evidence

This systematic review evaluates the real-world efficacy and safety of the 0.19 mg fluocinolone acetonide (FAc) sustained-release intravitreal implant for treating non-infectious uveitis affecting the posterior segment of the eye (NIU-PS). Following PRISMA guidelines, a search was conducted in PubMed, Embase and Web of Science, with the latest update on September 20, 2024. Twelve real-world studies involving a total of 382 patients (514 eyes) were included in the review. Compared to baseline, the studies consistently showed reduced mean central retinal thickness for up to 36 months post-FAc implantation, while mean visual acuity was stable or significantly improved. Intraocular inflammation, as per the Standardization of Uveitis Nomenclature grading system, was persistently absent or improved, with evidence extending to 12 months following implantation. While FAc generally showed potential to reduce or maintain systemic immunosuppressive treatments, this effect was not consistently observed, particularly in cases involving choroidal inflammation. Local rescue treatment was used in up to 24% of eyes. Mean intraocular pressure remained stable for 36 months with up to 38.5% of eyes requiring either supplemental or initial IOP-lowering medication. Limited data was available on cataract development. A few cases of hypotony as well as one case of retinal detachment were observed. Overall, current real-world evidence aligns with clinical trial findings, suggesting that the 0.19 mg FAc implant is an effective adjunctive maintenance treatment for NIU-PS with a consistent safety profile. Further studies are needed to refine treatment guidelines.