Repeat intravitreal triamcinolone acetonide injections in uveitic macular oedema

Sallam, Ahmed; Taylor, Simon; Habot‐Wilner, Zohar; Elgohary, Mostafa; Helen, H.; McCluskey, Peter; Lightman, Sue

doi:10.1111/j.1755-3768.2011.02247.x

Cited by 52 publications

(32 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Systemic anti-inflammatory medications in use also were recorded. Because most favorable effects associated with periocular corticosteroid injections occur within 1-6 months before the treatment wears off but ocular side effects occurring later than that were of interest, 3 we assessed the cumulative proportion of eyes experiencing favorable and unfavorable outcomes by 6 months and 12 months, respectively, from the time of the first injection.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, regional corticosteroids injections often are a useful adjunct to systemic treatment for uveitis, when there is persistent or refractory macular edema. 3 The use of regional corticosteroids for the treatment of macular edema (ME) or active intraocular inflammation in uveitis is well established and widespread. 4 Sub-Tenon's injections can be given repeatedly; typically the effect on active inflammation is observed within days to weeks and improvement in visual acuity or macular edema occurs within weeks to months.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Periocular Corticosteroid Injections in Uveitis

et al. 2014

View full text Add to dashboard Cite

Purpose To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders. Design Multicenter retrospective cohort study. Participants A total of 914 patients (1192 eyes) who had received at least one periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States. Methods Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers. Main Outcome Measures Control of inflammation, improvement of visual acuity to 20/40 or better, improvement of visual acuity loss attributed to macular edema, incident cataract affecting visual acuity, cataract surgery, ocular hypertension and glaucoma surgery. Results Among 914 patients (1192 eyes) who received at least one periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% [95% confidence interval (95%CI): 69.1-76.3] of the eyes achieved complete control of inflammation and 49.7% [95%CI:45.5-54.1] showed an improvement in visual acuity (VA) from worse than 20/40 to 20/40 or better. Among the subset with VA worse than 20/40 attributed to macular edema, 33.1% [95%CI: 25.2-42.7] improved to 20/40 or better. By 12 months, the cumulative incidence of one or more visits with an intraocular pressure≥24 mmHg and ≥30 mmHg was 34.0% [95%CI: 24.8-45.4] and 15.0% [95%CI: 11.8-19.1] respectively; glaucoma surgery was performed in 2.4% [95%CI: 1.4-3.9] of eyes. Within 12 months, among phakic eyes initially 20/40 or better, the incidence of a reduction in VA to worse than 20/40 attributed to cataract was 20.2% [95%CI: 15.9-25.6]; cataract surgery was performed within 12 months in 13.8 % [95%CI: 11.1-17.2] of the initially phakic eyes. Conclusion Periocular injections were effective in treating active intraocular inflammation and in improving reduced visual acuity attributed to macular edema in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, visual acuity improved in in half of the patients at some point within six months. However, cataract and ocular hypertension occurred in a substantial minority.

show abstract

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Periocular Corticosteroid Injections in Uveitis

et al. 2014

View full text Add to dashboard Cite

show abstract

“…The long-term prognosis of uveitic CME treated with IVTA injections has not been adequately evaluated [32,[34][35][36], but one recent study indicated no evidence of tachyphylaxis in response to repeated injections and no increase in the rates of IOP rise seen, although all phakic patients required cataract surgery by their fourth injection [37].…”

Section: Discussionmentioning

confidence: 98%

Review and update of intraocular therapy in noninfectious uveitis

Sallam

Taylor

Lightman

2011

Current Opinion in Ophthalmology

Self Cite

View full text Add to dashboard Cite

Ozurdex dexamethasone implant appears to have a better safety profile, and a slightly long-lasting effect than triamcinolone acetonide. The Retisert implant allows the release of corticosteroids at a constant rate for 2.5 years, but it requires surgical placement and its use is associated with a very high risk of cataract and requirement for IOP-lowering surgery. For patients who are steroid responders, methotrexate may offer a better alternative to corticosteroid treatment than anti-VEGF agents, but controlled trials are required to confirm this.

show abstract

“…There have been previous reports of repeated TA administration or increased TA dosage to treat recalcitrant and recurrent ME in uveitis. 22,23 Intravitreal TA has been shown to be effective in treating Behçet's uveitis, which often shows recurrent inflammation. 24,25 Our study also included a high proportion of patients with Behçet's uveitis, which also responded favorably to intravitreal TA administration.…”

Section: Discussionmentioning

confidence: 98%