This paper from South Korea reports on a prospective, double blind, randomised clinical study designed to evaluate the additional benefit of intravitreal triamcinolone (TA) administration for noninfectious uveitic macular oedema as an adjunct therapy to systemic anti-inflammatory treatment. Patients were randomised into two groups, the intravitreal TA injection group (TA group), and the sham group. Inclusion criteria specified central foveal thickness (CFT) >300 microns or thicker than the 99th percentile of normal distribution in any of the parafoveal areas. Patients in the TA group were administered intravitreal TA (4 mg/0.1 ml). Systemic corticosteroids or immunosuppressants and topical corticosteroids were administered to patients in both groups under the same policy. The primary outcome measure was the change in retinal thickness measured by SD-OCT at monthly follow-up visits until six months. Fifty eyes met the inclusion criteria. The causes of uveitis were similar in both groups, with intermediate uveitis or pars planitis, Behcet’s disease, and idiopathic posterior or panuveitis being the most frequent. In the TA group, the thickness of the central foveal area decreased significantly sooner than in the sham group. The parafoveal area thickness decreased more in the TA group than in the sham group at months two and three. The difference between the two groups was not significant after month four. The BCVA did not differ significantly between the two groups throughout the follow-up period and did not improve significantly from baseline in either group. The number of patients that showed decrease of leakage on FA to <1 disc diameter on their final visit was significantly greater in the TA group. The number of patients that were able to decrease systemic prednisolone to less than 10mg was significantly greater in the TA group. No patients required cataract surgery throughout the study period. When compared to baseline, the IOP was significantly increased at months one, two and three in the TA group. However, all cases with an IOP elevation above 22mmHg were controlled with medical therapy alone, and surgery was not required for IOP control in any case. 

Intravitreal triamcinolone injection for uveitic macular edema: a randomized clinical study.
Shin JY, Yu HG.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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