Local therapy in uveitis: Current concepts and emerging strategies

Local therapy plays a pivotal role in the management of noninfectious uveitis, providing targeted drug delivery with reduced systemic adverse effects. Advances in corticosteroid formulations and delivery routes have significantly improved therapeutic outcomes. Topical corticosteroids remain first-line for anterior uveitis, while periocular and intravitreal injections such as triamcinolone acetonide and dexamethasone implants (Ozurdex®) are effective for intermediate and posterior disease. Long-acting fluocinolone acetonide implants (Retisert®, Yutiq®) offer sustained control for chronic or recurrent cases, though ocular hypertension and cataract formation are common. The introduction of suprachoroidal corticosteroid delivery (Xipere®) allows precise posterior segment targeting with fewer anterior complications. Nonsteroidal intravitreal agents, including methotrexate and sirolimus, serve as steroid-sparing options, and topical immunomodulators such as cyclosporine and tacrolimus can be rarely used in chronic anterior uveitis. Emerging modalities like intravitreal biologics, nanocarrier systems, and gene-based delivery hold promise for long-term disease modulation. A tailored, evidence-based approach to local therapy can optimize inflammation control and visual outcomes in uveitis management.