IVTA use in Behçet’s disease
Reviewed by Saruban Pasu

This study aimed to evaluate the efficacy and safety of intravitreal triamcinolone acetonide (IVTA) injection (4mg/0.1ml) in controlling posterior segment inflammation in patients with Behçet’s disease. Medical records of consecutive patients diagnosed with Behçet’s who underwent IVTA between July 2005 and February 2001 were reviewed. Forty-nine eyes of 49 patients were included in the study. A total of 67.3% were on oral prednisolone of more than 10mg/day and 79.6% were on immunosuppressants. At 24 months after injection 49.0% were on a reduced dose or had stopped oral prednisolone and / or second line immunosuppressants. Mean number of acute attacks during one year before injection was 1.93+/-0.85, which reduced to 0.88+/-0.89 during one year after injection (p<0.001). Mean follow-up period after injection was 54.9+/-17.5 months. Mean best corrected visual acuity (BCVA) improved at 1, 3, 6, 12, 18, 24 and final visit (p<0.001). The cumulative survival of inflammation control without relapse was 40.0% at 12 months, 22.5% at 24 months, and 16.4% at 36 months after IVTA injection. During the 24 months after injection, 30.6% needed further injections at a median period of 10 months after the first. After injecting, 25% showed complete resolution of vascular and disc leakage on fundus flourescein angiography (FFA); 68.8% showed incomplete resolution. The cumulative probabilities of cataract surgery for phakic eyes were 13.8% at 12 months, 48.9% at 24 months and 60.2% at 36 months after IVTA injection. Twenty (40.8%) eyes had an elevated intraocular pressure (IOP) post injection. The rate of IOP elevation did not differ according to the history of glaucoma or IOP elevation history (p=0.740). Of these 20, 15 had no previous elevated IOP history and only one went on to have a trabeculectomy. Five patients with a post injection raised IOP had a previous history of elevated IOP and two of these underwent trabeculectomy. The authors conclude that although its anti-inflammatory effect is temporary and repeated injections are often necessary, IVTA injection is an effective therapeutic option for rapid vision restoration, inflammation control, and prevention of recurrence. Long-term follow-up revealed that ocular complications such as cataract progression and IOP elevation could decrease its efficacy and repeatability.

Long-term outcome of intravitreal triamcinolone acetonide injection for the treatment of uveitis attacks in Behçet disease.
Park UC, Park JH, Yu HG.
OCULAR IMMUNOLOGY AND INFLAMMATION
2014;22(1):27-33.