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H. A. Leder, D. A. Jabs, A. Galor, S. R. Kedhar, J. P. Dunn, Jr., G. B. Peters, III, J. E. Thorne; Posterior Subtenons Corticosteroid Injections for Cystoid Macular Edema Complicating Noninfectious Uveitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5631. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the effectiveness of posterior subtenon’s (PST) corticosteroid injection in the treatment of cystoid macular edema (CME) complicating noninfectious uveitis.
Patients with noninfectious uveitis and CME in at least 1 eye who received at least 1 PST injection were evaluated by chart review. Presence of CME was assessed clinically and when available, confirmed by fluorescein angiography and optical coherence tomography. Outcomes were resolution of CME 1 and 3 months after the first injection and the need for repeat injections. Failure of PST therapy was defined by the persistence of CME after 3 PST injections given consecutively over 3 months. Improvement in visual acuity at 1 and 3 months after injection also was assessed.
Of 126 patients studied, 27% had anterior uveitis, 21% intermediate uveitis, and 28% panuveitis. Uveitis was bilateral in 72%. At the time of first injection, CME was bilateral in 28% of patients, yielding 161 eyes. Of these, 53% demonstrated clinical resolution of CME at 1 month and 57% at 3 months after 1 PST injection. The estimated median time to CME resolution after 1 PST injection was 8 weeks. Of the 72 eyes with resolution of CME 1 month after 1 PST injection, 43 (60%) had no recurrence of CME 3 months after that injection. 30% of eyes (N=40) were treated with >1 PST injection because the CME persisted 1 month after the first injection (1 additional injection in 23 eyes; 2 injections in 16 eyes; 3 injections in 1 eye). Of the 40 eyes, 31 (78%) had no CME 1 month after the last PST injection and 22 (55%) had no CME 3 months after the last injection. The estimated median time to CME resolution after last injection in eyes receiving multiple injections was 14 weeks. 23 eyes (17%) failed PST therapy. Of 103 eyes initially responding to PST injection, CME recurred in 53% (median time to recurrence = 20 weeks). Patients receiving immunosuppressive therapy were less likely to have recurrence of CME (relative risk = 0.40; P = 0.02) independent of oral or topical corticosteroid use. Overall, a 3-line improvement in visual acuity was observed in 52% and 57% at the 1-month and 3-month visits, respectively.
Approximately 75% of eyes treated with PST injections for CME due to uveitis had resolution of CME 1 month after treatment, with ~50% demonstrating resolution of CME with a single PST injection. Recurrence of CME was common, although use of immunosuppressive drug therapy appeared to reduce this risk.
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