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F. Lee, C. Foster; Intracameral Triamcinolone in the Management of Severe Anterior Uveitis: A Retrospective Case Series. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5268.
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To evaluate the efficacy and adverse effects of intracameral triamcinolone in managing cases of severe, treatment resistant anterior uveitis
The medical records of the Massachusetts Eye Research and Surgery Institution were reviewed for patients who were treated with intracameral triamcinolone for anterior uveitis, and twelve patients were identified. Reduction in ocular inflammation, prior immunosuppressive and steroid therapy, progression of cataract, increase in intraocular pressure (IOP), and infection were evaluated.
Twelve patients (12 eyes) were identified as receiving anterior chamber injection of triamcinolone as treatment for anterior uveitis. A significant portion (58%) were notable for having HLA-B27 associated uveitis. Three patients received concomitant intravenous methylprednisolone, and of those, two were commenced on oral prednisone. Ten of twelve patients showed a cell grade reduction of 2 within 21 days or less, with an overall median reduction in cell grade of 3. All twelve patients achieved a cell count less than 1+ within 21 days or less. 58% were being treated with some form of immunosuppressive therapy. 75% were treated with topical steroid prior to intracameral injection, and 25% had failed to be controlled with previous periocular steroid injection. Median followup time was 23.5 months. Of nine patients who were phakic at the time of injection, two patients had already been scheduled for cataract extraction in the treatment eye prior to the injection and moved forward with surgery. Only one other patient required cataract surgery within one year following the injection. Three of the patients had a previous history of glaucoma, all of them controlled with prior surgical valve placement and/or topical hypotensive drops. Among the glaucoma patients, the maximum rise in IOP above baseline over 6 months was 9mmHg, and all three patients maintained IOP in the treatment eye less than 21 mmHg. Only one patient, without a past history of glaucoma, was measured with an IOP above 21 mmHg (30 mmHg, 14mmHg above baseline) in the treatment eye within 6 months of the injection, which did not require therapy and had resolved by the next follow-up visit. There was no incidence of post-procedure infection.
Intracameral injection of triamcinolone is an effective treatment option in instances of sight-threatening, treatment resistant uveitis requiring urgent care. Cataract, elevated IOP, and infection can be managed and avoided by careful screening of patients as candidates for the procedure.
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