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Xipere Injection – February, 2025

History:

A 76-year-old woman was followed in our clinic for posterior uveitis in both eyes (OU) after a negative infectious and inflammatory workup.

Exam:

Visual acuity (VA) was 20/60 In the right eye (OD) and 20/50-2 in the left eye (OS) with normal intraocular pressure OU. Left eye anterior segment was quiet with no injection, keratic precipitates, or AC cell. The iris had mild diffuse atrophy, and the pseudophakic lens was well centered. Posterior segment exam revealed no vitritis, mild venous tortuosity with no vascular sheathing, and 2+ macular edema (Fig 1). Following several triamcinolone intravitreal injections most recently 5 months prior with persistent macular edema, the decision was made to perform a suprachoroidal Xipere injection. The patient returned 1 month later with 20/30 VA OS and significantly reduced macular edema (Fig 2).

Discussion:

Xipere Injection

Xipere is an FDA approved triamcinolone acetonide injection for suprachoroidal use. The suprachoroidal space is a potential space located between the sclera and choroid. The space typically remains collapsed but is able to expand to accommodate fluid often in pathologic states such as suprachoroidal hemorrhage or effusion.

The suprachoroidal space has recently been explored as an effective alternative to intravitreal administration of medications. Potential advantages include slower clearance and decreased diffusion into the anterior segment with better targeting of the chorioretinal tissue.

Xipere is indicated for treatment of macular edema associated with noninfectious uveitis. PEACHTREE was the first phase 3 trial for Xipere in which patients with noninfectious uveitis treated with Xipere. The study resulted in vision improvement relative to sham therapy demonstrating the efficacy of suprachoroidal steroid injection for the treatment of macular edema.

As demonstrated by the notable improvement of macular edema following the suprachoroidal triamcinolone injection in our patient, the safety and efficacy of this drug delivery method holds promise for ocular therapeutics.

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References:

1. Hancock SE, Wan CR, Fisher NE, Andino RV, Ciulla TA. Biomechanics of suprachoroidal drug delivery: From benchtop to clinical investigation in ocular therapies. Expert Opin Drug Deliv. 2021 Jun;18(6):777-788. doi: 10.1080/17425247.2021.1867532. Epub 2021 Jan 3. PMID: 33393391.
2. Rahman S, Tayyab H, Siddiqui MAR. Suprachoroidal Triamcinolone Acetonide Injection to Treat Macular Edema: A Review. J Vitreoretin Dis. 2024 Oct 17:24741264241275271. doi: 10.1177/24741264241275271. Epub ahead of print. PMID: 39539834; PMCID: PMC11556382.
3. Naftali Ben Haim L, Moisseiev E. Drug Delivery via the Suprachoroidal Space for the Treatment of Retinal Diseases. Pharmaceutics. 2021 Jun 26;13(7):967. doi: 10.3390/pharmaceutics13070967. PMID: 34206925; PMCID: PMC8309112.
4. Yeh S, Khurana RN, Shah M, Henry CR, Wang RC, Kissner JM, Ciulla TA, Noronha G; PEACHTREE Study Investigators. Efficacy and Safety of Suprachoroidal CLS-TA for Macular Edema Secondary to Noninfectious Uveitis: Phase 3 Randomized Trial. Ophthalmology. 2020 Jul;127(7):948-955. doi: 10.1016/j.ophtha.2020.01.006. Epub 2020 Jan 10. PMID: 32173113.
5. Henry CR, Walter SD, Chang PY, Warrow DJ, Naeini PE, Blinder KJ, Brevetti T, Yassine M, Dacey MS, Chu DS, Raiji VR, Rifkin LM, Shah M, Singer MA. Early adoption of triamcinolone acetonide suprachoroidal injection for uveitic macular edema: a physician survey. BMC Res Notes. 2024 Oct 23;17(1):317. doi: 10.1186/s13104-024-06969-4. PMID: 39444009; PMCID: PMC11515593.