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

https://doi.org/10.1016/j.ajo.2008.09.011Get rights and content

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.

Section snippets

Patients and Methods

In this monocenter, prospective, randomized clinical trial, 40 patients (40 eyes) were included. All patients had vision-limiting cataract in the presence of chronic endogenous uveitis. All patients underwent phacoemulsification with posterior chamber acrylic foldable IOL implantation. No inflammation should have been present for at least three months before surgery. Known steroid responders, diabetics, and patients complaining of other ocular disorders were excluded.

Patients were randomly

Results

The two groups did not differ regarding age, gender, cataract score, presence of posterior synechiae (Group 1, n = 10; Group 2, n = 11), anatomic uveitis form, and associated diseases. The most common systemic diseases were sarcoidosis, spondylarthritis, and chronic inflammatory bowel disease. Differences between groups concerning BCVA (logMAR), systemic immunosuppression, laser flare values, mean foveal thickness (OCT), and CME before surgery were marginal (Table 1). In Group 1, 50% of

Discussion

Dada and Okhravi recently reported satisfactory visual outcome after intravitreal triamcinolone (TA) treatment in patients with endogenous uveitis after phacoemulsification, and Dada observed an anti-inflammatory effect comparable to that provided by oral prednisolone (1 ml/kg/d).5, 7 Local application of steroids appears to be particularly attractive, as the probability of systemic side effects is lower. For intravitreal TA, particularly high intraocular steroid levels, but also several side

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