Risk factors for failing sub-Tenon's triamcinolone acetonide for uveitic macular edema.
Corticosteroid injections
Intravitreal corticosteroids
Intravitreal dexamethasone implant
Sub-tenon’s triamcinolone acetonide
Uveitic macular edema
Uveitis
Journal
Journal of ophthalmic inflammation and infection
ISSN: 1869-5760
Titre abrégé: J Ophthalmic Inflamm Infect
Pays: Germany
ID NLM: 101553216
Informations de publication
Date de publication:
01 Feb 2024
01 Feb 2024
Historique:
received:
12
11
2023
accepted:
08
01
2024
medline:
1
2
2024
pubmed:
1
2
2024
entrez:
31
1
2024
Statut:
epublish
Résumé
Sub-Tenon's triamcinolone acetonide (STA) is less effective than intravitreal corticosteroids in the treatment of uveitic macular edema (ME), but does have some relative advantages, including substantially lower cost and decreased risk of post-injection ocular hypertension. It would be useful for clinicians to know which eyes may respond well to STA and not necessarily require intravitreal therapy. The objective of this study is to identify risk factors for failing STA for the treatment of uveitic ME. A retrospective cohort study was performed. Medical records were reviewed of patients who underwent STA for the treatment of uveitic ME between January 1, 2013, and July 31, 2022, at the University of Colorado Hospital. Uveitic ME was defined by a central subfield thickness (CST) greater than 320 μm or the presence of intra-retinal cystoid spaces on optical coherence tomography (OCT), or by the presence of petaloid macular leakage on fluorescein angiography (FA). Data collected included age, race/ethnicity, sex, history of diabetes mellitus, anatomic classification of uveitis, use of corticosteroids, use of immunomodulatory therapy, presence of intra-retinal fluid on OCT, CST on OCT, and presence of petaloid macular leakage on FA. STA failure was defined as the need for additional therapy within 12 weeks of STA due to persistent or worsening uveitic ME. One hundred eighty eyes from 131 patients were included. Forty-two eyes (23.3%) were considered treatment failures. In univariate and multivariable analysis, higher baseline CST was associated with a higher likelihood of failing STA (OR 1.17 for each 30 μm increase in CST, P = 0.016). STA, while not as potent as intravitreal corticosteroids for the treatment of uveitic ME, was still an effective therapy, particularly for patients with lower baseline CST. Given its lower side effect profile and cost compared to intravitreal treatments, clinicians could consider STA as an initial treatment for mild uveitic ME.
Sections du résumé
BACKGROUND
BACKGROUND
Sub-Tenon's triamcinolone acetonide (STA) is less effective than intravitreal corticosteroids in the treatment of uveitic macular edema (ME), but does have some relative advantages, including substantially lower cost and decreased risk of post-injection ocular hypertension. It would be useful for clinicians to know which eyes may respond well to STA and not necessarily require intravitreal therapy. The objective of this study is to identify risk factors for failing STA for the treatment of uveitic ME.
MAIN BODY
METHODS
A retrospective cohort study was performed. Medical records were reviewed of patients who underwent STA for the treatment of uveitic ME between January 1, 2013, and July 31, 2022, at the University of Colorado Hospital. Uveitic ME was defined by a central subfield thickness (CST) greater than 320 μm or the presence of intra-retinal cystoid spaces on optical coherence tomography (OCT), or by the presence of petaloid macular leakage on fluorescein angiography (FA). Data collected included age, race/ethnicity, sex, history of diabetes mellitus, anatomic classification of uveitis, use of corticosteroids, use of immunomodulatory therapy, presence of intra-retinal fluid on OCT, CST on OCT, and presence of petaloid macular leakage on FA. STA failure was defined as the need for additional therapy within 12 weeks of STA due to persistent or worsening uveitic ME. One hundred eighty eyes from 131 patients were included. Forty-two eyes (23.3%) were considered treatment failures. In univariate and multivariable analysis, higher baseline CST was associated with a higher likelihood of failing STA (OR 1.17 for each 30 μm increase in CST, P = 0.016).
CONCLUSIONS
CONCLUSIONS
STA, while not as potent as intravitreal corticosteroids for the treatment of uveitic ME, was still an effective therapy, particularly for patients with lower baseline CST. Given its lower side effect profile and cost compared to intravitreal treatments, clinicians could consider STA as an initial treatment for mild uveitic ME.
Identifiants
pubmed: 38296910
doi: 10.1186/s12348-024-00386-1
pii: 10.1186/s12348-024-00386-1
doi:
Types de publication
Journal Article
Langues
eng
Pagination
7Informations de copyright
© 2024. The Author(s).
Références
Multicenter Uveitis Steroid Treatment Trial Research G, Kempen JH, Altaweel MM, Holbrook JT, Jabs DA, Sugar EA (2010) The multicenter uveitis steroid treatment trial: rationale, design, and baseline characteristics. Am J Ophthalmol 149(4):550–561 e10. https://doi.org/10.1016/j.ajo.2009.11.019
doi: 10.1016/j.ajo.2009.11.019
Grajewski RS, Boelke AC, Adler W et al (2016) Spectral-domain optical coherence tomography findings of the macula in 500 consecutive patients with uveitis. Eye (Lond) 30(11):1415–1423. https://doi.org/10.1038/eye.2016.133
doi: 10.1038/eye.2016.133
pubmed: 27391933
Kempen JH, Van Natta ML, Altaweel MM et al (2015) Factors predicting visual acuity outcome in intermediate, posterior, and Panuveitis: the Multicenter Uveitis Steroid Treatment (MUST) Trial. Am J Ophthalmol 160(6):1133–1141 e9. https://doi.org/10.1016/j.ajo.2015.09.017
doi: 10.1016/j.ajo.2015.09.017
pubmed: 26386159
pmcid: 4657141
Tomkins-Netzer O, Lightman S, Drye L et al (2015) Outcome of Treatment of Uveitic macular edema: the Multicenter Uveitis Steroid Treatment Trial 2-year results. Ophthalmology 122(11):2351–2359. https://doi.org/10.1016/j.ophtha.2015.07.036
doi: 10.1016/j.ophtha.2015.07.036
pubmed: 26359188
Thorne JE, Sugar EA, Holbrook JT et al (2019) Periocular triamcinolone vs. Intravitreal triamcinolone vs. Intravitreal dexamethasone implant for the Treatment of Uveitic macular edema: the PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial. Ophthalmology. 126(2):283–295. https://doi.org/10.1016/j.ophtha.2018.08.021
doi: 10.1016/j.ophtha.2018.08.021
pubmed: 30269924
Schallhorn JM, Niemeyer KM, Browne EN, Chhetri P, Acharya NR (2018) Difluprednate for the Treatment of Uveitic cystoid macular edema. Am J Ophthalmol 191:14–22. https://doi.org/10.1016/j.ajo.2018.03.027
doi: 10.1016/j.ajo.2018.03.027
pubmed: 29580977
Leder HA, Jabs DA, Galor A, Dunn JP, Thorne JE (2011) Periocular triamcinolone acetonide injections for cystoid macular edema complicating noninfectious uveitis. Am J Ophthalmol 152(3):441–448 e2. https://doi.org/10.1016/j.ajo.2011.02.009
doi: 10.1016/j.ajo.2011.02.009
pubmed: 21652023
Jung JL, Harasawa M, Patnaik JL, Palestine AG (2022) Subtenon triamcinolone Acetonide injection with topical anesthesia in pediatric non-infectious Uveitis. Ophthalmol Therapy 11(2):811–820. https://doi.org/10.1007/s40123-022-00480-4
doi: 10.1007/s40123-022-00480-4
Roesel M, Gutfleisch M, Heinz C, Heimes B, Zurek-Imhoff B, Heiligenhaus A (2009) Intravitreal and orbital floor triamcinolone acetonide injections in noninfectious uveitis: a comparative study. Ophthalmic Res 42(2):81–86. https://doi.org/10.1159/000220600
doi: 10.1159/000220600
pubmed: 19478546
Salek SS, Leder HA, Butler NJ, Gan TJ, Dunn JP, Thorne JE (2013) Periocular triamcinolone acetonide injections for control of intraocular inflammation associated with uveitis. Ocul Immunol Inflamm 21(4):257–263. https://doi.org/10.3109/09273948.2013.767353
doi: 10.3109/09273948.2013.767353
pubmed: 23617776
Couch SM, Bakri SJ (2009) Intravitreal triamcinolone for intraocular inflammation and associated macular edema. Clin Ophthalmol 3:41–47. https://doi.org/10.2147/opth.s4477
doi: 10.2147/opth.s4477
pubmed: 19668543
pmcid: 2708981
Lowder C, Belfort R Jr, Lightman S et al (2011) Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol 129(5):545–553. https://doi.org/10.1001/archophthalmol.2010.339
doi: 10.1001/archophthalmol.2010.339
pubmed: 21220619
Young S, Larkin G, Branley M, Lightman S (2001) Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis. Clin Exp Ophthalmol 29(1):2–6. https://doi.org/10.1046/j.1442-9071.2001.00360.x
doi: 10.1046/j.1442-9071.2001.00360.x
pubmed: 11272779
Berkenstock MK, Mir TA, Khan IR et al (2022) Effectiveness of the Dexamethasone Implant in Lieu of Oral Corticosteroids in Intermediate and Posterior Uveitis Requiring Immunosuppression. Ocul Immunol Inflamm 30(3):741–749. https://doi.org/10.1080/09273948.2020.1826534
doi: 10.1080/09273948.2020.1826534
pubmed: 33021854
McKay KM, Borkar DS, Sevgi DD, Susarla G, Papaliodis GN, Sobrin L (2021) Comparison of modified posterior sub-Tenon's vs. trans-septal triamcinolone injection for non-infectious Uveitis. Ocul Immunol Inflamm 29(5):857–864. https://doi.org/10.1080/09273948.2019.1698748
doi: 10.1080/09273948.2019.1698748
pubmed: 31902274
Venkatesh P, Kumar CS, Abbas Z, Garg S (2008) Comparison of the efficacy and safety of different methods of posterior subtenon injection. Ocul Immunol Inflamm 16(5):217–223. https://doi.org/10.1080/09273940802209153
doi: 10.1080/09273940802209153
Pharmacoeconomic review report: dexamethasone (Ozurdex) (2018) (Allergan Inc): indication: for the treatment of adult patients with diabetic macular edema who are pseudophakic. CADTH Common Drug Reviews
Zhang C, Friedman S, Mruthyunjaya P, Parikh R (2023) The Biosimilar Paradox: How Anti-VEGF Biosimilars will Increase Patient and Overall Healthcare Costs. Ophthalmology 26. https://doi.org/10.1016/j.ophtha.2023.04.019