Intravitreal injection of triamcinolone acetonide during chronic severe uveitis

Abstract

Abstract: : Purpose:Recent therapeutic concepts in the management of ocular inflammation have led to the use of intravitreal injections of corticosteroids. Such treatment is well–known for inducing intraocular pressure elevation, but its effectiveness and tolerance in uveitis is not yet established. Methods:A retrospective review to evaluate efficacy and tolerance of one or more intravitreal injections of 0.4 mg of triamcinolone acetonide was performed from june 2002 to june 2003. Patients affected by corticosteroid–induced glaucoma were excluded. Efficacy of the treatment was evaluated by visual acuity measurement, fluorescein angiography and optical coherence tomography. Side effects were recorded. Ocular pressure was monitored before and after injections. Results:One to three injections were performed in 22 eyes of 16 patients suffering from non infectious uveitis resistant to conventional therapy. The mean age was 42.9 years (6 to 67 years). Intraocular pressure increased in 5 eyes (22.7 %). Medical treatment was successful to control intraocular pressure in all cases within a week. In one pseudophakic eye, triamcinolone acetonide spread into the anterior chamber, but vanished within 5 days without any consequence. Retinal detachment occurred in one eye. Improvement of visual acuity of at least two lines occurred in 11 eyes (50 %). Control of inflammation on fluorescein angiography and OCT was achieved in 13 eyes (59.1%) but systemic corticosteroids were tapered in 3 additional eyes. The mean follow–up was 5.2 months after the last injection (3 to 11 months). Conclusions:Intravitreal injection of triamcinolone acetonide in chronic non infectious uveitis is an effective and relatively safe procedure. Intraocular pressure elevation is not frequent and easily controlled. These preliminary results suggest a fast and lasting effectiveness of intravitreal injections in the treatment of uveitis. However, larger control studies and long term follow–up are needed before drawing further conclusions.

Keywords: inflammation • corticosteroids • intraocular pressure