Single Low-dose Suprachoroidal Triamcinolone Acetonide Injection in Macular Edema Secondary to Noninfectious Posterior Uveitis

Abstract

Purpose: The purpose was to study the anatomical and functional outcome following single low-dose suprachoroidal triamcinolone acetonide (LD-SCTA) (2 mg) injection in noninfectious posterior uveitis.

Methods: Eleven patients with macular edema (ME) more than 280 μ secondary to noninfectious uveitis were included in the study. A single LD-SCTA (0.5 ml) injection was performed in the study eye with the help of a novel suprachoroidal microneedle (Pricon, Iscon Surgicals, Jodhpur, Rajasthan, India). The study parameters were noted at 4 and 12 weeks post LD-SCTA injection.

Results: Ten of 11 patients had a significant decrease in central macular thickness (CMT). The mean CMT measurement at baseline was 513.6 ± 191.73 μm for the 10 patients who responded to the treatment, which reduced significantly to 265.1 ± 34.72 μm (P < 0.003) and 260.6 ± 34.72 μm (P < 0.002) at 4 and 12 weeks, respectively. The mean best-corrected visual acuity (BCVA) at baseline was 0.84 ± 0.41 logMAR unit which improved to 0.52 ± 0.33 (P < 0.001) and 0.25 ± 0.22 (P < 0.000) at weeks 4 and 12, respectively. The mean intraocular pressure at baseline recorded was 16.36 ± 2.97 mmHg, 19.45 ± 4.80 mmHg (P = 0.06) at 4 weeks, and 17.27 ± 2.53 mmHg (P = 0.35) at 12 weeks. One eye which did not respond to LD-SCTA was a case of recurrent Vogt-Koyanagi-Harada disease.

Conclusion: Single LD-SCTA injection is efficacious in reducing CMT in ME, improving BCVA, and controlling the inflammation in noninfectious posterior uveitis. LD-SCTA can be used as a first-line therapy in noninfectious uveitis over other routes of steroid administration with a favorable outcome and safety profile.

Keywords: Low-dose suprachoroidal triamcinolone acetonide; macular edema; noninfectious uveitis; suprachoroidal triamcinolone.

Figure 1

The 30 G needle with a stop and 0.9 mm tip length to access the suprachoroidal space

Figure 2

Line graph showing central macular thickness in treatment success study subjects at baseline and at 4 and 12 weeks. CMT: Central macular thickness

Figure 3

Line diagram showing individual change in best-corrected visual acuity compared to baseline at 4 and 12 weeks, respectively. BCVA: Best-corrected visual acuity

Figure 4

Fundus photograph and optical coherence tomography (OCT) of the left eye of a 23-year-old male patient with Eales’ disease with central macular edema. (a) At baseline, fundus photo showing exudation and sheathing along the inferotemporal arcade with central macular edema. (b) At 4 weeks, decrease in size of exudation and sheathing. OCT shows the resolution of macular edema with decrease in hyperreflective foci. (c) At 12 weeks, complete resolution of exudation and sheathing. The foveal contour is normal on OCT

Figure 5

Fundus photograph and optical coherence tomography (OCT) of the right eye of a 60-year-old female with Vogt–Koyanagi–Harada. (a) At baseline, fundus photo shows hyperemic disc with blurring of disc margin suggestive of inflammatory disc edema and obscuration of choroidal vessels due to exudative retinal detachment. OCT shows subretinal fluid at macula. (b) At 4 weeks, fundus photo shows the resolution of disc edema with resolution of exudative retinal detachment. OCT shows the resolution of subretinal fluid at macula

Figure 6

Line diagram showing individual change of intraocular pressure compared to baseline at 4 and 12 weeks, respectively. IOP: Intraocular pressure