Investigators sought to determine whether intravitreal or oral steroids were more effective at postsurgical inflammation control in patients with uveitis.
This 12-week, single-center, prospective study randomized 40 patients with inactive uveitis to either an intraoperative 4 mg/0.1 mL injection of intravitreal triamcinolone (IVTA) or perioperative oral prednisone 0.5 mg/kg/day starting 5 days prior to cataract surgery with a protocol-mandated taper after cataract surgery. Patients then underwent cataract surgery with IOL placement, and were treated postoperatively with topical steroids and cycloplegics per protocol.
At weeks 1 and 4 following surgery, the IVTA group had significantly less inflammation than the prednisone group, but this difference between the groups disappeared by week 12. No patients in either group had a recurrence of uveitis. While there were no significant differences between the treatment groups in terms of BCVA, central macular thickness, or IOP, 5 patients given IVTA had postoperative IOP >21 mm Hg.
The overall sample size was small and was limited to eyes without a prior history of steroid-related complication and no cystoid macular edema at baseline. There was no discussion of systemic steroid-related side effects.
Control of inflammation in the perioperative period of cataract surgery is critical in patients with uveitis, and IVTA offers a safe and effective method to control inflammation while limiting systemic side effects. Given these promising early results, a larger multicenter clinical trial is needed to find out how patients will do overall.
Financial Disclosures: Dr. Sumit Sharma discloses financial relationships with Abbvie, Alimera Sciences, Bausch + Lomb, Clearside Biomedical, Regenxbio (Consultant/Advisor); EyePoint Pharmaceuticals, Genentech, Regeneron Pharmaceuticals (Consultant/Advisor, Grant Support); Gilead Sciences, Ionis, Santen (Grant Support).