Effectiveness of Intravitreal Triamcinolone Acetate in Refractory Uveitic Cystoid Macular Oedema

Abstract

Abstract: : Purpose: Report efficacy and safety of intravitreal triamcinolone acetate (ivit TA) in the treatment of refractory uveitic cystoid macular oedema (CME). Methods: Noncomparative (nonrandomized, noncontrolled) prospective interventional case series of 65 eyes of 54 patients with uveitis related CME resistant to a minimum of 2 periocular corticosteroid injections given 6 weeks apart and/or a course of oral corticosteroid. Additional immunosuppressive drugs were used if clinically indicated. Following ivit TA, visual acuity (VA), intraocular pressure (IOP), levels of inflammation and immunosuppressive therapy were assessed as outcome measures. Potential complications were looked for. Results: Mean follow up was 8.0 months (range 3–51). Mean improvement in logmar VA after ivit TA was 0.26 (0.65 to 0.39). The dosage of oral corticosteroid and/or second line immunosuppressive medication could be reduced or stopped in 18 out of 33 eyes (54.5%). The most significant side effect was raised IOP with 28 eyes (43.1%) experiencing an IOP rise of >10 mmHg. Thirty three eyes (51%) were treated with antiglaucoma medications with mean duration of treatment of 17.4±13.3 weeks. In all cases the IOP rise was transient. No patient required trabeculectomy. There were no cases of injection related vitreous haemorrhage, endophthalmitis or retinal detachment. Conclusions: Ivit TA is a safe and potent additional therapy for refractory uveitic CME that improves VA, reduces CME and in some eyes allows cessation and/or reduction of immunosuppressive therapy. Ivit TA is associated with a rise in IOP in a large number of eyes, but this appears to be transient and treatable medically.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • uveitis-clinical/animal model • macula/fovea