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04-10-2018 | Ophthalmology | News | Article

Intravitreal superior to periocular therapy for initial uveitic ME

medwireNews: Treatment with intravitreal triamcinolone acetonide (ITA) or intravitreal dexamethasone implant (IDI) results in greater improvements in uveitic macular oedema (ME) than treatment with periocular triamcinolone acetonide (PTA), US research shows.

And although the intravitreal treatments were associated with “modest increases” in intraocular pressure (IOP) compared with periocular treatment, Jennifer Thorne (The Johns Hopkins School of Medicine, Baltimore, Maryland) and co-investigators say their findings “suggest that intravitreal therapy may be the preferred initial therapy for uveitic ME.”

At 8 weeks’ posttreatment, all study participants had statistically and clinically significant reductions in central subfield thickness relative to baseline.

However, the 39% reduction observed with ITA (n=77 eyes) and the 46% reduction with IDI (n=76 eyes) were both significantly larger than the 23% reduction observed with PTA (n=74 eyes).

The proportion of patients with at least a 20% decrease in macular thickness at 8 weeks was significantly greater with both intravitreal treatments than with periocular treatment, at around 80% versus 40%.

Likewise, at 8 weeks significantly more patients in the intravitreal groups had resolution of uveitic ME, defined as a macular thickness less than 260 µm, than in the periocular group, at around 45–60% versus 20%.

The researchers note that the differences between the two treatment types were evident from weeks 4 to 12, but attenuated by week 24. This was “likely because approximately one third of eyes in the periocular group received intravitreal corticosteroid therapy during follow-up”, they write in Ophthalmology.

Thorne et al add: “These findings suggest that both ITA and the IDI are superior to [PTA] in both speed of improvement/resolution and sustainability of effect.”

The team also found that best-corrected visual acuity (BCVA) improved significantly in all treatment groups throughout follow-up, but the improvement was a significant five letters greater in both the ITA and IDI groups than in the PTA group at weeks 8 and 24.

“Taken together, the retinal thickness and BCVA data suggest that although all 3 regional corticosteroids are effective in treating uveitic ME, treatment via the intravitreal approach is superior to that of the periocular approach regardless of the type of corticosteroid used”, Thorne and co-authors remark.

They also report that although “the development of severe IOP elevations was uncommon”, the risk of having IOP at or above 24 mmHg was a significant 1.83- and 2.52-fold higher with ITA and IDI, respectively, than with PTA.

Finally, the researchers highlight that there were no significant differences between the two intravitreal treatment groups for any of the outcomes tested.

They say that their findings “were comparable to previous publications investigating the effectiveness of PTA, ITA, and the IDI individually.”

By Laura Cowen

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