High Dose Intravitreal Kenalog for the Treatment of Immune Recovery Uveitis Macular Edema

Abstract

Abstract: : Purpose: To evaluate the use of high dose intravitreal triamcinolone acetate for the treatment of macular edema secondary to immune recovery uveitis (IRU) in patients with Acquired Immune Deficiency Syndrome (AIDS). Methods: Consecutive, interventional case series of 6 eyes in 5 patients followed at the University of California, San Diego AIDS Ocular Treatment Unit who underwent an intravitreal injection of 20mg of decanted triamcinolone acetate for fluorescein angiographically proven IRU related macular edema. The primary outcome measure was vision (utilitizing the ETDRS chart). Other outcome measures included: fluorescein angiographic leakage and Stratus OCT measurement of macular volume and thickness. Results: The average pre–injection vision was 23 letters on the ETDRS chart, and the average post–injection vision was 35 letters on the ETDRS chart. Average visual improvement overall was 2.1 lines on the ETDRS chart. Average pre–injection volume of macular edema as measured with OCT was 8.78mm³, and average pre–injection retinal thickness was 332 microns. The average post–injection volume of macular edema as measured with OCT was 7.67mm³, and average post–injection retinal thickness was 207microns. All patients showed improvement of their macular edema with fluorescein angiography. This study is currently ongoing with further follow–up pending. Conclusions: Our previous study showed that treatment with subtenon methylprednisolone acetate for the treatment of macular edema of IRU was only marginally effective. However, this study showed that high dose decanted intravitreal triamcinolone acetate can be an effective treatment for macular edema secondary to IRU in patients with AIDS. None of our patients had reactivation of CMV retinitis.

Keywords: uveitis-clinical/animal model • corticosteroids • AIDS/HIV