Steroid treatment for pseudophakic cystoid macular oedema
Reviewed by Kurt Spiteri Cornish

The authors present a retrospective comparison of 45 eyes of 41 patients treated with 2mg intravitreal triamcinolone (IVT group) and 50 eyes of 42 patients treated with 40mg sub-Tenons triamcinolone (STT group) for pseudophakic cystoid macular oedema (CMO). The visual acuity (VA) prior to injection was worse in the IVT groups (0.84 versus 0.55 logMAR), reflecting physicians’ preference to treat worse pathology with IVT. Improvement in VA was statistically significant (compared to baseline) and similar in the two groups at all post-procedural time points (one, three and six months). There was a mean gain of 2.3 lines in the IVT group and 2.4 lines in the STT group. Overall, 42.3% of patients required re-treatment (55.6% of the IVT group and 32% of the STT group) within 2.9 (STT) to 3.5 (IVT) months of the first treatment. Both groups had a significant improvement in central macular thickness (CMT) compared to baseline, but the improvement was more significant in the IVT group (256µm versus 187µm) at one month. Improvement in CMT was similar at month three and six. The main adverse event in these patients was ocular hypertension (OHT), which occurred in 6.7-12% of eyes. All cases of OHT were successfully controlled with topical treatment. In summary, patients receiving IVT or STT both gained approximately two lines of vision with a reduction of CMT of approximately 200µm at month six, however, the resolution was faster in the IVT group. More patients in the IVT group required re-treatment due to recurrent CMO. This may represent a shorter duration of action of IVT when compared to STT. More research is needed to characterise a temporal difference in efficacy between the two treatments, and to help clarify the optimal treatment pattern in eyes with CMO.

Resolution of pseudophakic cystoid macular edema: 2 mg intravitreal triamcinolone acetonide versus 40 mg posterior sub-tenon triamcinolone acetonide.
Kuley B, Storey PP, Wibbelsman TD, et al.
CURRENT EYE RESEARCH
2021;46(6):824-30.