Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology

Justine R Smith; Jennifer E Thorne; Christina J Flaxel; Nieraj Jain; Stephen J Kim; Maureen G Maguire; Shriji Patel; Christina Y Weng; Steven Yeh; Leo A Kim

doi:10.1016/j.ophtha.2024.02.019

Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology

Ophthalmology. 2024 Apr 20:S0161-6420(24)00158-1. doi: 10.1016/j.ophtha.2024.02.019. Online ahead of print.

Authors

Affiliations

¹ College of Medicine and Public Health, Flinders University, Adelaide, South Australia.
² Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
³ Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
⁴ Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
⁵ Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee.
⁶ Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
⁷ Vitreoretinal Diseases & Surgery, Baylor College of Medicine, Cullen Eye Institute, Houston, Texas.
⁸ Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska.
⁹ Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.

PMID: 38647511
DOI: 10.1016/j.ophtha.2024.02.019

Abstract

Purpose: To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema.

Methods: A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients.

Results: This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation.

Conclusions: The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: corticosteroid; macular edema; noninfectious; ocular; uveitis.