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Intravitreal triamcinolone allows cataract surgery in uveitic eyes, pilot study finds

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Injecting intravitreal triamcinolone acetonide during cataract surgery may be a reasonable alternative to systemic corticosteroids for controlling intraocular inflammation in eyes with posterior uveitis, a pilot study suggests.

Narciss Okhravi, FRCOphth, PhD, and colleagues at Moorfields Eye Hospital, London, evaluated the use of the drug in 19 eyes of 17 patients who averaged 54 years of age. In all cases, patients had posterior uveitis that surgeons said they believed would require a course of prophylactic systemic corticosteroids preoperatively.

However, "the use of systemic corticosteroids at the time of surgery would have been problematic in seven of the patients, who had a history of systemic hypertension," the authors said in the study, noting that three of the seven hypertensive patients also had diabetes.

"All patients were not happy about using oral corticosteroids," they said.

Surgeons injected 40 mg of triamcinolone acetonide intravitreally through the pars plana after inserting a posterior chamber IOL, according to the study.

Visual acuity averaged 20/100 preoperatively and improved to an average of 20/40 at 1 day postop.

At 25.2 months mean follow-up, 17 eyes (89.5%) had achieved a visual acuity of 20/40 or better. Of the remaining two eyes, one had developed optic atrophy and the other had developed macular edema.

Three eyes developed macular edema 19 to 30 weeks postop, two of which had such episodes preoperatively. Three eyes also had an increase in IOP, which was controlled by 3 months of topical medication. One other patient developed severe postop intraocular inflammation, which resolved within 1 week of treatment with intensive topical corticosteroids, according to the study.

"No eye developed macular edema within 4 months of surgery; that is, during the time [intravitreal triamcinolone] was expected to remain in the eye," the authors said.

The study is published in the July issue of Journal of Cataract and Refractive Surgery.