Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis

Roesel, Martin; Heinz, Carsten; Koch, Jörg; Heiligenhaus, Arnd

doi:10.1007/s00417-009-1269-1

Cited by 20 publications

(11 citation statements)

References 27 publications

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“…This is consistent with a series of cataract in eyes with a history of uveitis but also of uncomplicated phacoemulsification surgery in healthy eyes (Rosel et al. ; Şahin et al. ).…”

Section: Discussionsupporting

confidence: 91%

“…Others have found that in a cohort of non‐infectious uveitis patients a single intraoperative orbital floor injection of triamcinolone acetonide was as effective in postoperative inflammation, macular oedema and visual outcome as a 4‐week course of postoperative oral prednisolone (Rosel et al. ).…”

Section: Discussionmentioning

confidence: 99%

“…One stated that a 2-week course of oral prednisolone, tapered postoperatively, produced better recovery of the blood-aqueous barrier damage than a single dose of intravenous methylprednisolone, and the authors recommended the oral perioperative regimen (Meacock et al 2004). Others have found that in a cohort of non-infectious uveitis patients a single intraoperative orbital floor injection of triamcinolone acetonide was as effective in postoperative inflammation, macular oedema and visual outcome as a 4-week course of postoperative oral prednisolone (Rosel et al 2010).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two‐centre, prospective, randomized trial

Mora

Gonzales

Ghirardini

et al. 2016

Acta Ophthalmologica

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Absolute and long-lasting control of ocular, and possibly systemic, inflammation predisposes uveitis patients to satisfactory results after cataract extraction and intraocular lens implantation. Despite a lower rate of recurrences following oral steroid supplementation, the efficacy of an intensive perioperative topical steroid regimen alone in preventing postoperative uveitis relapse was statistically comparable. Secondary outcomes were also comparable between the two groups. Transient IOP elevation should be expected until treatment discontinuation.

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“…This is consistent with a series of cataract in eyes with a history of uveitis but also of uncomplicated phacoemulsification surgery in healthy eyes (Rosel et al. ; Şahin et al. ).…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two‐centre, prospective, randomized trial

Mora

Gonzales

Ghirardini

et al. 2016

Acta Ophthalmologica

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“…In patients with unilateral or asymmetric disease, or in whom systemic administration of medication is less desirable, e.g. during pregnancy or in patients with a history of gastric ulceration, periocular injection can be useful to provide a depot of corticosteroid that successfully reaches the posterior segment to control inflammation [18-20]. …”

Section: Reviewmentioning

confidence: 99%

Local therapies for inflammatory eye disease in translation: past, present and future

et al. 2013

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Despite their side-effects and the advent of systemic immunosuppressives and biologics, the use of corticosteroids remains in the management of patients with uveitis, particularly when inflammation is associated with systemic disease or when bilateral ocular disease is present. The use of topical corticosteroids as local therapy for anterior uveitis is well-established, but periocular injections of corticosteroid can also be used to control mild or moderate intraocular inflammation. More recently, intraocular corticosteroids such as triamcinolone and steroid-loaded vitreal inserts and implants have been found to be effective, including in refractory cases. Additional benefits are noted when ocular inflammation is unilateral or asymmetric, when local therapy may preclude the need to increase the systemic medication.Implants in particular have gained prominence with evidence of efficacy including both dexamethasone and fluocinolone loaded devices. However, an appealing avenue of research lies in the development of non-corticosteroid drugs in order to avoid the side-effects that limit the appeal of injected corticosteroids. Several existing drugs are being assessed, including anti-VEGF compounds such as ranibizumab and bevacizumab, anti-tumour necrosis factor alpha antibodies such as infliximab, as well as older cytotoxic medications such as methotrexate and cyclosporine, with varying degrees of success. Intravitreal sirolimus is currently undergoing phase 3 trials in uveitis and other inflammatory pathways have also been proposed as suitable therapeutic targets. Furthermore, the advent of biotechnology is seeing advances in generation of new therapeutic molecules such as high affinity binding peptides or modified high affinity or bivalent single chain Fab fragments, offering higher specificity and possibility of topical delivery.

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“…during pregnancy or in patients with a history of gastric ulceration, periocular injection can be useful to provide a depot of corticosteroid that successfully reaches the posterior segment to control inflammation [14,25,26,27,28]. The precise mechanisms by which locally injected corticosteroids enter the eye are not known [9], but systemic drug levels remain low, and corticosteroids can be found in all layers of the eye, even at 30 days after a single sub-Tenon injection of 40 mg of triamcinolone acetate, the highest levels being found in the choroid and retinal pigment epithelium [29].…”

Section: Periocular Corticosteroid Administrationmentioning

confidence: 99%

New Developments in Corticosteroid Therapy for Uveitis

et al. 2010

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Corticosteroids remain the mainstay of the management of patients with uveitis. Topical corticosteroids are effective in the control of anterior uveitis, but vary in strength, ocular penetration and side effect profile. Systemic corticosteroids are widely used for the management of posterior segment inflammation which requires treatment, particularly when it is associated with systemic disease or when bilateral ocular disease is present. However, when ocular inflammation is unilateral, or is active in one eye only, local therapy has considerable advantages, and periocular injections of corticosteroid are a useful alternative to systemic medication and are very effective in controlling mild or moderate intraocular inflammation. More recently, the injection of intraocular corticosteroids such as triamcinolone have been found to be effective in reducing macular oedema and improving vision in uveitic eyes which have proved refractory to systemic or periocular corticosteroids. The effect is usually transient, lasting around 3 months, but can be repeated although the side effects of cataract and raised intraocular pressure are increased in frequency with intraocular versus periocular corticosteroid injections. This has led to the development of new intraocular corticosteroid devices which are designed to deliver sustained-release drugs and obviate the need for systemic immunosuppressive treatment. The first such implant was Retisert, which is surgically implanted (in the operating theatre) and is designed to release fluocinolone over a period of about 30 months. More recently, Ozurdex, a ‘bioerodible’ dexamethasone implant which can be inserted in an office setting, has completed phase III clinical trials in patients with intermediate and posterior uveitis. This implant lasts approximately 6 months, and has been found to be effective with a much better side effect profile than Retisert or intravitreal triamcinolone injection, at least for one injection.

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Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis

Abstract: A single intraoperative orbital floor injection of triamcinolone acetonide is as effective on postoperative inflammation, macular edema, and visual outcome as a 4-week course of postoperative oral prednisolone in cataract surgery with IOL implantation in uveitis patients.

Cited by 20 publications

References 27 publications

Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two‐centre, prospective, randomized trial

Perioperative prophylaxis to prevent recurrence following cataract surgery in uveitic patients: a two‐centre, prospective, randomized trial

Local therapies for inflammatory eye disease in translation: past, present and future

New Developments in Corticosteroid Therapy for Uveitis

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