Intravitreal triamcinolone acetonide as adjunctive treatment with systemic therapy for uveitic macular edema

Purpose. To report the outcome of a single intravitreal triamcinolone acetonide (IVTA) injection as an adjunctive treatment with systemic medication for refractory uveitic cystoid macular edema (CME). Methods. This was a retrospective, noncomparative, interventional case series. Medical records of 25 patients (35 eyes) with quiescent uveitic CME who were treated with oral immunosuppressive therapy and underwent 4 mg/0.1 mL IVTA injection were reviewed. Data was collected 6 months post-injection and included details of uveitis, best-corrected visual acuity (BCVA), CME, systemic therapy required, and potential complications of IVTA injection. Results. Thirty eyes (85%) responded with improvement in vision. The mean BCVA improvement was 0.33 (from 0.67 to 0.34 logarithm of the minimum angle of resolution; Snellen equivalent, between 2 and 3 lines) (p<0.001), at a mean time of 6.2 weeks (range 2-16). Resolution of CME was achieved in 31 (88%) of the treated eyes. Following initial response to IVTA, CME relapsed in 8 eyes (26%) after a mean time of 4.2 months (range 2.5-5.5). The dosage of oral corticosteroids and/or second-line immunosuppressive agents was able to be reduced or stopped in 22 patients, 29 of 35 eyes (82.8%). The most common adverse effect was increased intraocular pressure, in 17 (49%) of the treated eyes. Steroid-induced cataract was observed in 6 eyes (17%). Conclusions. Intravitreal triamcinolone acetonide appears to be an effective supplementary tool in the management of CME refractory to systemic immunosuppressive therapy. Retreatment might be required in some and may be associated with elevated intraocular pressure and cataract.