Short-term Safety and Efficacy of Intravitreal Triamcinolone Acetonide for Uveitic Macular Edema in Children

Abstract

To evaluate the short-term safety and efficacy of intravitreal (IV) triamcinolone acetonide (TA) for treating pediatric cystoid macular edema (CME) secondary to noninfectious uveitis. Methods: A retrospective noncomparative interventional case series. The medical records of 15 consecutive children (16 eyes) with uveitic CME treated with IVTA (2 or 4 mg) were reviewed. Data collected included details of uveitis, CME, visual acuity, intraocular pressure, and cataract development. The median follow-up time was 16 months (range, 9-36 months). Results: Resolution of CME was achieved in all of the treated eyes. The median time taken for CME to resolve was 3 weeks (range, 1-24 weeks). The mean improvement of visual acuity after IVTA was 0.6 logarithm of the minimum angle of resolution. Following initial response to IVTA, CME relapsed in 5 eyes (31%) after a median time of 7 months (range, 3-13 months). The most common adverse effect was increased intraocular pressure, with an increase of more than 15 mm Hg in 5 eyes (31%). Steroid-induced cataract was observed in 6 of 11 phakic eyes (55%). Conclusions: We found that IVTA is efficacious in the treatment of uveitic CME in children and results in CME resolution and visual acuity improvement. As in adults, treatment in children may be associated with elevated intraocular pressure and cataract.

Intravitreal Bevacizumab Versus Triamcinolone Acetonide for Refractory Uveitic Cystoid Macular Edema: A Randomized Pilot Study

“…No major intravitreal injection-related complications were encountered in our study except vitreous hemorrhage that developed in 1 eye (IVT group), which resolved spontaneously. In contrast to other reports,6–8 , 10 , 23 , 24 no ocular hypertension (≥23 mm Hg) was observed in our study. This could be due to the lower dosage (2 mg) of triamcinolone.…”

“…In 12 eyes, second injections and in 8 eyes, third injections were needed. Similar beneficial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone 6–10…”

“…Similar benefi cial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone. [6][7][8][9][10] Transient reduction of CMT following IVB injection in eyes with uveitic CME has been reported by 2 earlier mentioned studies. 4 , 11 improvement between the groups with a standard deviation equal to 0.2 at the 2-sided 5% level and power of 80%.…”

Intravitreal Bevacizumab Versus Triamcinolone Acetonide for Refractory Uveitic Cystoid Macular Edema: A Randomized Pilot Study

“…No major intravitreal injection-related complications were encountered in our study except vitreous hemorrhage that developed in 1 eye (IVT group), which resolved spontaneously. In contrast to other reports,6–8 , 10 , 23 , 24 no ocular hypertension (≥23 mm Hg) was observed in our study. This could be due to the lower dosage (2 mg) of triamcinolone.…”

“…In 12 eyes, second injections and in 8 eyes, third injections were needed. Similar beneficial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone 6–10…”

“…Similar benefi cial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone. [6][7][8][9][10] Transient reduction of CMT following IVB injection in eyes with uveitic CME has been reported by 2 earlier mentioned studies. 4 , 11 improvement between the groups with a standard deviation equal to 0.2 at the 2-sided 5% level and power of 80%.…”

Management of lipid exudates in Coats disease by adjuvant intravitreal triamcinolone: effects and complications

“…Development of glaucoma in a single case and cataract in six out of 15 cases (40%) after intravitreal injection points to a direct causal relationship to TA. This was also observed by others when using 2 or 4 mg TA intravitreal injection for uveitic macular oedema in children 25. To our knowledge, this is the first report demonstrating the long-term effects of 4 mg intravitreal TA injection on eyes suffering from Coats disease on follow-up.…”

Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis

“…Sijssens et al [22] reported that children with JIA-associated uveitis treated with periocular steroids are at higher risk of experiencing secondary glaucoma compared with children with uveitis not associated with JIA after a follow-up of five years. In a study by Sallam et al [23], intravitreal triamcinolone acetonide-induced ocular hypertension greater than 15 mmHg was seen in nearly one-third of the pediatric uveitis cases, a finding in accordance with previous work on adults with uveitis treated by intravitreal triamcinolone. The onset of a triamcinolone acetonide-induced increase in IOP occurred earlier in children as compared with adults.…”

Intravitreal Bevacizumab Versus Triamcinolone Acetonide for Refractory Uveitic Cystoid Macular Edema: A Randomized Pilot Study

“…No major intravitreal injection-related complications were encountered in our study except vitreous hemorrhage that developed in 1 eye (IVT group), which resolved spontaneously. In contrast to other reports,6–8 , 10 , 23 , 24 no ocular hypertension (≥23 mm Hg) was observed in our study. This could be due to the lower dosage (2 mg) of triamcinolone.…”

“…In 12 eyes, second injections and in 8 eyes, third injections were needed. Similar beneficial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone 6–10…”

“…Similar benefi cial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone. [6][7][8][9][10] Transient reduction of CMT following IVB injection in eyes with uveitic CME has been reported by 2 earlier mentioned studies. 4 , 11 improvement between the groups with a standard deviation equal to 0.2 at the 2-sided 5% level and power of 80%.…”

Management of lipid exudates in Coats disease by adjuvant intravitreal triamcinolone: effects and complications

“…Development of glaucoma in a single case and cataract in six out of 15 cases (40%) after intravitreal injection points to a direct causal relationship to TA. This was also observed by others when using 2 or 4 mg TA intravitreal injection for uveitic macular oedema in children 25. To our knowledge, this is the first report demonstrating the long-term effects of 4 mg intravitreal TA injection on eyes suffering from Coats disease on follow-up.…”

Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis

“…Sijssens et al [22] reported that children with JIA-associated uveitis treated with periocular steroids are at higher risk of experiencing secondary glaucoma compared with children with uveitis not associated with JIA after a follow-up of five years. In a study by Sallam et al [23], intravitreal triamcinolone acetonide-induced ocular hypertension greater than 15 mmHg was seen in nearly one-third of the pediatric uveitis cases, a finding in accordance with previous work on adults with uveitis treated by intravitreal triamcinolone. The onset of a triamcinolone acetonide-induced increase in IOP occurred earlier in children as compared with adults.…”

Intravitreal Bevacizumab Versus Triamcinolone Acetonide for Refractory Uveitic Cystoid Macular Edema: A Randomized Pilot Study

“…No major intravitreal injection-related complications were encountered in our study except vitreous hemorrhage that developed in 1 eye (IVT group), which resolved spontaneously. In contrast to other reports,6–8 , 10 , 23 , 24 no ocular hypertension (≥23 mm Hg) was observed in our study. This could be due to the lower dosage (2 mg) of triamcinolone.…”

“…In 12 eyes, second injections and in 8 eyes, third injections were needed. Similar beneficial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone 6–10…”

“…Similar benefi cial long-term effects of IVT on VA have been reported with both 2 and 4 mg triamcinolone. [6][7][8][9][10] Transient reduction of CMT following IVB injection in eyes with uveitic CME has been reported by 2 earlier mentioned studies. 4 , 11 improvement between the groups with a standard deviation equal to 0.2 at the 2-sided 5% level and power of 80%.…”

Management of lipid exudates in Coats disease by adjuvant intravitreal triamcinolone: effects and complications

“…Development of glaucoma in a single case and cataract in six out of 15 cases (40%) after intravitreal injection points to a direct causal relationship to TA. This was also observed by others when using 2 or 4 mg TA intravitreal injection for uveitic macular oedema in children 25. To our knowledge, this is the first report demonstrating the long-term effects of 4 mg intravitreal TA injection on eyes suffering from Coats disease on follow-up.…”

Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis

“…Sijssens et al [22] reported that children with JIA-associated uveitis treated with periocular steroids are at higher risk of experiencing secondary glaucoma compared with children with uveitis not associated with JIA after a follow-up of five years. In a study by Sallam et al [23], intravitreal triamcinolone acetonide-induced ocular hypertension greater than 15 mmHg was seen in nearly one-third of the pediatric uveitis cases, a finding in accordance with previous work on adults with uveitis treated by intravitreal triamcinolone. The onset of a triamcinolone acetonide-induced increase in IOP occurred earlier in children as compared with adults.…”