Comparison Between Intravitreal and Orbital Floor Triamcinolone Acetonide After Phacoemulsification in Patients With Endogenous Uveitis

• Published in: American journal of ophthalmology Vol. 147; no. 3; pp. 406 - 412
• Main Authors: Roesel, Martin, Tappeiner, Christoph, Heinz, Carsten, Koch, Joerg M, Heiligenhaus, Arnd
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2009; Elsevier; Elsevier Limited
• Subjects: Anti-Inflammatory Agents - administration & dosage; Biological and medical sciences; Cataracts; Chronic Disease; Clinical trials; Drug Administration Routes; Eye surgery; Female; Glaucoma; Humans; Hypertension; Injections; Lens Implantation, Intraocular; Macular Edema - drug therapy; Macular Edema - etiology; Macular Edema - physiopathology; Male; Medical imaging; Medical sciences; Middle Aged; Miscellaneous; Ophthalmology; Optics; Orbit; Phacoemulsification; Postoperative Care; Prospective Studies; Pseudophakia - physiopathology; Standard deviation; Steroids; Surgery; Tomography; Triamcinolone Acetonide - administration & dosage; Uvea diseases; Uveitis - complications; Uveitis - drug therapy; Uveitis - physiopathology; Vascular endothelial growth factor; Visual Acuity - physiology; Vitreous Body; Human; Floor of the orbit; Corticosteroid; Antiinflammatory agent; Vitreous body; Uvea disease; Phacoemulsification; Acetonide; Eye disease; Endogenous; Treatment; Surgery; Adrenal hormone; Uveitis; Ophthalmology; Triamcinolone; Comparative study
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2008.09.011

Purpose To compare the effect of intravitreal and orbital floor triamcinolone acetonide (TA) on macular edema, visual outcome, and course of postoperative inflammation after cataract surgery in uveitis patients. Design Prospective, randomized clinical trial. Methods Monocenter study (40 patients) with chronic endogenous uveitis who underwent phacoemulsification with intraocular lens implantation with either 4 mg intravitreal TA (n = 20) or 40 mg orbital floor TA (n = 20). The primary outcome was influence on cystoid macular edema (CME). Secondary outcome measures were best-corrected visual acuity (BCVA), anterior chamber cell grade, laser flare photometry, giant cell deposition, posterior capsule opacification (PCO), and intraocular pressure. Results Mean central foveal thickness decreased in the intravitreal TA group and increased in the orbital floor TA group ( P < .001 at one and three months). CME improved in 50% of patients after intravitreal TA, whereas it was unchanged after orbital floor TA (difference between the groups at three months, P = .049). Mean BCVA (logarithm of the minimal angle of resolution) improved postoperatively ( P < .001) from 0.76 and 0.74 to 0.22 and 0.23 in the intravitreal TA and orbital floor TA group, respectively. Anterior chamber cell count at one month was lower in the intravitreal TA than in the orbital floor TA group ( P = .02). Laser flare photometry values and giant cell numbers were slightly higher after orbital floor TA than after intravitreal TA. The groups did not differ with respect to PCO rate and ocular hypertension. Conclusions The CME improvement and anti-inflammatory effect after intravitreal TA was better than after orbital floor TA injection in cataract surgery in uveitis patients.