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Stephen J. Turner, Sreekanth Sreekantam, Alastair K. Denniston, Philip I. Murray; Efficacy And Safety Of Posterior Sub-tenon Triamcinolone Injection Using A Cannula For The Treatment Of Uveitic Cystoid Macular Oedema. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2756.
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Cystoid macular oedema (CMO) is a very common sight threatening complication of uveitis. Periocular corticosteroid injections appear to be the treatment of choice for unilateral CMO, but the best technique of administration has yet to be determined. The purpose of this study was to assess the efficacy and safety of posterior sub-Tenon triamcinolone injections using a supero-temporal quadrant approach with a cannula in patients with CMO complicating non-infectious uveitis (for comparison with the intravenous cannula, Smith & Nozik and orbital floor methods).
72 consecutive treatments were delivered to 62 eyes of 55 patients over a 30 month period in a single centre. Primary outcome measures included the baseline and 8 week logMAR visual acuity, the spectral domain optical coherence tomography (SD-OCT) central 1mm retinal thickness (CRT) and improvement and resolution of cystoid macular oedema at 8 weeks. Other outcome measures included intraocular pressure change and the side effect profile.
31% had anterior uveitis, 25% had intermediate uveitis and 44% had panuveitis. 69% were female and 32% were pseudophakic. At 8 weeks there was complete resolution of cystoid macular oedema on SD-OCT in 40/72 eyes (56%), but 5/72 eyes (7%) required a second injection for residual macular oedema. Median baseline and 8 week post treatment logMAR visual acuities were 0.60 (range 0.07-1.78) and 0.18 (range 0-1.30) (p<0.01, 95% CI 0.2, 0.4) respectively. At least 3 lines of improvement in logMAR visual acuity was seen in 48/72 eyes (67%). Median baseline and 8 week post treatment CRTs were 512 microns (range 221-918 microns) and 314 microns (range 178-723 microns) (p<0.01, 95% CI 159.6, 234.8). Median percentage improvement in CRT at 8 weeks was 34.3% (-0.07-60.7%). Mean baseline IOP was 13.6 +/- 3.3 mmHg. Mean post treatment IOP was 16.9 +/- 5.7 mmHg. 4 eyes had IOP greater than 30 mmHg, and 9 eyes required topical ocular hypotensive treatment.
56% of treatments resulted in complete resolution of CMO on SD-OCT after a single injection, with halving of the visual angle occuring in a total of 67%. These results suggest that the sub-Tenon cannula method compares favourably with other reported techniques and has an excellent safety profile.
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