Echography-Verified Retrobulbar Triamcinolone Injection in the Treatment of Uveitis
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- Category: Vol. 77, June 2009
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Echography-Verified Retrobulbar Triamcinolone Injection in the Treatment of Uveitis,MAHMOUD M. GAMAL, YASMINE M. EL-SAYED and KHALID ABU EL EINEIN
Abstract
The Purpose: The aim of the present study is to assess the efficacy of sonography-verified retrobulbar injecition (RBI) of Triamcinolone acetonide (TAA) in the treatment of uveitis and the management of persistent and refractory uveitic macular edema (ME).
Subjects and Methods: In this prospective study 26 eyes of 20 patients were included. Patients underwent RBI of TAA for intraocular inflammation and/or cystoid macular edema (CME) caused by chronic non-infective anterior, intermediate, posterior or pan uveitis. Patients with ocular hypertension or glaucoma were excluded from the study. The etiology of uveitis, Snellen visual acuity (VA) in decimal fraction, appla-nation intraocular pressure (IOP) were recorded, anterior segment findings were evaluated by slit lamp and posterior segment findings by ophthalmoscopy, slit lamp biomicroscopy or ultrasonography. Fundus fluorescein angiography (FFA) was performed whenever the ocular media allowed. The primary outcome measures were: Improvement of uveitis (inflammatory activity), angiographic appearance of CME at 6 months of follow-up and change in VA.
Results: There were 9 cases of Behcet's disease (45%), 4 cases of VKH (20%), 2 cases of intermediate uveitis (10%) and 5 cases of idiopathic uveitis (25%) There was a statistically significant improvement of visual acuity (VA) after injection in all patients with a p-value of 0.045. Complete resolution of anterior uveitis occurred in 6 eyes in the 1st week, 4 eyes in the 2nd week and 2 eyes in the 1st month. One case (2 eyes) failed to achieve complete resolution at the end of follow-up (7%). Regarding vitreous inflammatory activity, complete resolution occurred in 6 eyes in the 1st week, 4 eyes in the 2nd week, 3 eyes in the 1st month, 4 eyes in the 2nd month and 5 eyes in the 3rd month. 4 eyes failed to achieve complete resolution at the end of follow-up (14%). Although the IOP tended to be temporarily higher after injection, the increase in IOP was not statistically significant.
Conclusion: Sonographic confirmation of the paramacular location of depot steroids after RBI can potentially raise the therapeutic success in refractory uveitis and CME; although the effect may be transient. The procedure is relatively safe. Week 2 is the most probable time for the development of a high IOP. The most significant therapeutic effect of retrobul-barly-injected TAA on inflammatory activity appears at 4weeks; however, its effect in terms of patient satisfaction and reduction in CME is maintained for as long as 4 months.