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  • Treatment for Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies - IN PRESS

    AAO OTAC Retina/Vitreous Panel, Hoskins Center for Quality Eye Care
    Retina/Vitreous
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    Abstract

     A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Retina/Vitreous Panel.

    Justine R. Smith, FRANZCO, PhD,1 Jennifer E. Thorne, MD, PhD,2 Christina J. Flaxel, MD,3 Nieraj Jain, MD,4 Stephen J. Kim, MD,5 Maureen G. Maguire, PhD,6 Shriji Patel, MD, MBA,5 Christina Y. Weng, MD, MBA,7 Steven Yeh, MD,4, 8, * Leo A. Kim, MD, PhD9, *

    Ophthalmology, In Press © 2024 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Purpose: To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for non-infectious uveitic macular edema.

    Methods: A literature search of the PubMed database was last conducted in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and there were no date restrictions. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, and/or suprachoroidal corticosteroid injection for uveitic macular edema; (2) had outcomes that included visual acuity and/or macular edema assessed clinically or imaged by optical coherence tomography and/or fluorescein angiography; and (3) included more than 20 patients.

    Results: This assessment reviewed 23 articles that provided level I or II evidence from 18 studies on the use of periocular, suprachoroidal and intravitreal triamcinolone acetonide injections, and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in non-infectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved visual acuity (VA) and/or improved macular structure. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure (IOP) and accelerate cataract formation.

    Conclusions: The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of non-infectious uveitic macular edema. However, there is limited information on the relative effectiveness and complication rates across the different therapies.

    1College of Medicine and Public Health, Flinders University, Adelaide, South Australia
    2Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
    3Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
    4Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
    5Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
    6Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
    7Vitreoretinal Diseases & Surgery, Baylor College of Medicine, Cullen Eye Institute, Houston, Texas
    8Department of Ophthalmology, Truhlsen, Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska
    9Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston Massachusetts
    *Steven Yeh and Leo Kim share last authorship.