This study compares the effectiveness of 3 regional corticosteroid injections for uveitic macular edema (ME): periocular triamcinolone acetonide (PTA), intravitreal triamcinolone acetonide (ITA) and the intravitreal dexamethasone implant (IDI).
Study design
Patients in this multicenter, randomized control trial were randomized 1:1:1 to the treatment arms based on the presence or absence of systemic treatment for their underlying uveitis. Those with bilateral macular edema received the same treatment arm in both eyes.
The primary outcome was improvement in central subfield thickness (CST) from baseline at 8 weeks, as assessed on OCT by masked readers. Secondary outcomes included BCVA, IOP changes and a 20% or greater improvement or resolution in macular edema. The study included patients with both active and inactive uveitis. Patients were not excluded if they had a history of glaucoma.
Outcomes
All treatment groups had a clinically meaningful reduction in CST at 8 weeks (23%, 39% and 46% for PTA, ITA and IDI, respectively). Intravitreal triamcinolone acetonide and intravitreal dexamethasone implant were superior to periocular triamcinolone acetonide, but there were no significant differences between the intravitreal regimens. All groups showed improvements in BCVA, with comparable findings in the intravitreal groups, and significantly less improvements in the PTA group.
There was an associated increased risk of IOP elevation within the intravitreal treatment arms; this risk was similar between the 2 intravitreal regimens.
Limitations
Second injections were not standardized between the arms because of the different pharmacokinetics of the underlying corticosteroids. In addition, treatment changes were allowed after 8 weeks, which complicates interpretation of the findings after this time period. Activity or control of the underlying uveitis was not assessed, and the study included participants with both active and inactive uveitis. This could influence the results if a greater proportion of eyes with active inflammation ended up in 1 treatment arm.
Clinical significance
This study provides a randomized controlled comparison of the 3 most commonly used local corticosteroid treatment regimens in all uveitis patient types. The findings should help guide therapy for patients who present with uveitic macular edema.