Consecutive Dexamethasone–Fluocinolone Acetonide Therapy in Non-Infectious Uveitic Macular Edema: Real-World Outcomes

PURPOSE: To evaluate the efficacy and durability including a consecutive intravitreal corticosteroid treatment strategy involving dexamethasone (DEX) followed by fluocinolone acetonide (FAc), in non-infectious uveitis with macular edema (UME). METHODS: This real-world study included 80 eyes from 62 patients, receiving a total of 164 intravitreal injections (124 DEX and 40 FAc). Functional and anatomical outcomes were assessed using best-corrected visual acuity (BCVA) and central macular thickness (CMT). Longitudinal associations were analyzed using linear mixed-effects models to account for clustering at the patient and eye levels. Outcomes also included treatment response, durability, and retreatment intervals. RESULTS: DEX implantation resulted in rapid and significant improvements in BCVA and CMT, with peak effects observed at approximately 4 weeks; however, anatomical benefits were often time-limited, necessitating reinjection. FAc implantation provided sustained anatomical stabilization, low retreatment rates, and prolonged durability, with a median retreatment interval of 35 months. Eyes receiving DEX followed by FAc achieved effective long-term disease control and a reduced treatment burden. Adverse events, including intraocular pressure elevations, were transient and manageable. CONCLUSION: A consecutive DEX-to-FAc treatment strategy offers sustained disease control and may reduce treatment burden in patients with chronic disease.