• fluocinolone implants
• iluvien
• intravitreal implants
• noninfectious uveitis
• ozurdex
• posterior uveitis
• yutiq

• Humans
• Drug Implants
• Uveitis, Posterior/drug therapy
• Uveitis, Posterior/diagnosis
• Glucocorticoids/administration & dosage
• Intravitreal Injections
• Uveitis, Intermediate/drug therapy
• Uveitis, Intermediate/diagnosis
• Dexamethasone/administration & dosage
• Fluocinolone Acetonide/administration & dosage
• Visual Acuity

• Corticosteroids
• treatment
• triamcinolone acetonide; dexamethasone; fluocinolone acetonide
• uveitic macular edema
• uveitis

• Uveitis
• cystoid macular edema
• macular hole
• pars plana vitrectomy
• rhegmatogenous retinal detachment

• Humans
• Uveitis/diagnosis
• Uveitis/surgery
• Vitreoretinal Surgery
• Vitrectomy
• Visual Acuity/physiology

• Cystoid macular edema
• postoperative
• suprachoroidal
• triamcinolone acetonide injection
• uveitis

• Clinical trial
• Diagnosis
• Drug delivery
• Microneedle
• New therapy
• Polymer

• Skin
• Administration, Cutaneous
• Drug Delivery Systems
• Microinjections
• Needles

• children
• complications
• macular edema
• risk factors
• uveitis

• CD5
• Intercellular adhesion molecule marker ICAM-1
• Macular edema
• Molecular markers
• Recurrent anterior uveitis

• Humans
• Macular Edema/etiology
• Macular Edema/complications
• Intercellular Adhesion Molecule-1
• Uveitis/complications
• Uveitis, Anterior/diagnosis
• Uveitis, Anterior/complications
• T-Lymphocytes
• Biomarkers

Triamcinolone acetonide injectable suspension for suprachoroidal use (Xipere^®; SCS triamcinolone acetonide) is a corticosteroid approved in the USA for the treatment of macular edema associated with uveitis. Suprachoroidal injection of SCS triamcinolone acetonide results in preferential distribution into the posterior segment, which may reduce the risk of corticosteroid-related adverse events, such as cataracts and intraocular pressure (IOP) elevation. In a multicenter phase III trial in patients with non-infectious uveitic macular edema, SCS triamcinolone acetonide significantly and rapidly improved visual acuity and reduced signs of macular edema compared with sham treatment. SCS triamcinolone acetonide was generally well tolerated, with the most common adverse event being eye pain on the day of the procedure. The risk of corticosteroid-related IOP elevation appeared to be reduced in unrescued patients in the SCS triamcinolone acetonide group compared with patients in the sham control group who received rescue therapy. SCS triamcinolone acetonide is a novel and useful treatment option for uveitic macular edema.

Uveitic macular edema is a major cause of blindness in the developed world. Intravitreal and periocular application of corticosteroids (e.g., triamcinolone acetonide) may be effective for uveitis and macular edema, but these routes are often associated with cataracts and corticosteroid-related intraocular pressure (IOP) elevation. Recently, a triamcinolone acetonide suspension for injection into the suprachoroidal space (Xipere^®; SCS triamcinolone acetonide) has been approved for the treatment of uveitic macular edema. The suprachoroidal route preferentially distributes the drug to the back of the eye, resulting in a reduced risk of corticosteroid-related adverse events. In a pivotal clinical trial, SCS triamcinolone acetonide rapidly improved visual acuity and resolved macular edema in patients with non-infectious uveitis. SCS triamcinolone acetonide was generally well tolerated, with the most common ocular adverse event being eye pain on the day of procedure. In unrescued patients in the SCS triamcinolone acetonide group, there appeared to be a reduced risk of corticosteroid-related IOP elevation versus patients who received rescue therapy in the sham control group. SCS triamcinolone acetonide is a novel and useful treatment option for uveitic macular edema.

Posterior uveitis represents the second most frequent type of uveitis (15–30% of all uveitis). Noninfectious posterior uveitis complicated with secondary cystoid macular edema (CME) affects the visual prognosis negatively. The objective of the current study is to detect possible microvascular changes causing relapsing uveitis-related CME using optical coherence tomography angiography (OCTA).

This is an interventional, observational, retrospective study with 1 year follow-up. Patients with noninfectious, posterior uveitis-related CME undergoing dexamethasone (DEX) implant were evaluated. Following the DEX-implant were carried out control visits after 1 month, 2-months, 4-months, 6-months, and for up 1-year. A total of 76 eyes of 38 consecutive patients with noninfectious posterior uveitis were enrolled (consecutive sample). Complicated noninfectious posterior uveitis with secondary CME was diagnosed in 56 eyes of uveitis patients (73.7%) and reviewed.

Our investigation showed (1) a reduction in superficial vessel plexus (SVP) measurements within 2-month (84%), reaching 96.4% for up 1-year, (2) an irregular profile of SVP in 69.6% of cases, persisting for up 1-year; relapsing uveitis-related CME eyes with irregular superficial foveal avascular zone (FAZ) profile were in 51%, while the SVP measurements reestablished in 100% of cases. Conversely, (3) the deep vascular plexus (DVP) parameters restored in a lower number of eyes within the 2-month (39.3%), remaining abnormal in 46.4% of cases for up 1-year; despite DVP restored in 53.6% of cases for up 1 year, (4) a capillary rarefaction ring around the FAZ appeared in 80.4% of cases; the relapsing uveitis-related CME eyes with abnormal DVP parameters were present in 41% of cases, of which 92.1% showed a rarefaction ring had abnormal DVP.

The use of OCTA enabled the evaluation in detail of retinal microvascular changes. We suggested that the possibility of the recurrence of the uveitis-related CME depends on the persistence of modifications of the superficial and deep layers. In this regard, we propose to implement the current imaging armamentarium with OCTA for the follow-up of patients with noninfectious uveitis-related CME.

The use of steroids to treat macular edema (ME) is a research hotspot in ophthalmology. We utilized CiteSpace and VOSviewer software to evaluate the Web of Science Core Collection publications and to build visualizing maps to describe the research progress in this topic. There were 3,252 publications for three decades during 1988–2021. The number of studies was low during the first 14 years but has risen consistently in the following two decades. The average publications per year were only 4.8 during 1988–2002, which jumped to 113 per year during 2003–2012, and 227 per year during 2013–2021. These publications came from 83 countries/regions, with the United States, Germany, and Italy leading positions. Most studies were published in Investigative Ophthalmology Visual Science, and Ophthalmology was the most cited journal. We found 9,993 authors, with Bandello F having the most publications and Jonas JB being the most frequently co-cited. According to our research, the most popular keyword is triamcinolone acetonide (TA). Macular edema, diabetic macular edema (DME), retinal vein occlusion (RVO), dexamethasone (DEX), fluocinolone acetonide (FA), and some other keywords were commonly studied in this field. In conclusion, the bibliometric analysis provides a comprehensive overview of steroid hotspots and developmental tendencies in the macular edema study. While anti-VEGF therapy is the first-line treatment for DME and RVO-induced macular edema, steroids implant is a valid option for these DME patients not responding to anti-VEGF therapy and non-DME patients with macular edema. Combined therapy with anti-VEGF and steroid agents is vital for future research.

• VOSviewer
• bibliometric study
• citespace
• intravitreal injection
• macular edema
• steroids

Introduction 

One of the leading causes of blindness throughout the world is uveitis, which predominantly results in the feared complication of macular edema. We report the safety and efficacy of suprachoroidal injection of triamcinolone acetonide in the treatment of macular edema secondary to noninfectious uveitis. 

Methodology 

This prospective, nonrandomized interventional study was conducted at Layton Rahmatullah Benevolent Trust (LRBT) Eye Hospital, Lahore, from August 2019 till July 2020. All individuals older than 18 years, nonpregnant females with a central macular thickness of >320 µm were included. Those patients with uncontrolled diabetes, immunodeficiency, or any other disease mandating systemic corticosteroid use were excluded. All patients had a detailed ocular exam one week before the treatment, and 0.1 ml of triamcinolone acetonide 40 mg/ml was injected using a 30-G hollow needle into the suprachoroidal space. After the injection, an eye patch was applied and the patient was observed for three hours. All data were documented in a preformed proforma. 

Results

A total of 30 patients were included in the study with a mean age of 38.1 ± 9.48 years. Statistically significant differences were found between central macular thickness at presentation and at one and three months of the procedure, i.e., 569.60 ± 170.396, 266.77 ± 73.127, and 208.27 ± 37.292 µm, respectively. A similar difference was observed when comparing visual acuity at baseline to visual acuity at one and three months of the procedure (p < 0.001). 

Conclusion 

The current study indicates that a single dose of suprachoroidal injection of triamcinolone acetonide for the treatment of macular edema secondary to uveitis is safe and efficacious. No rise in intraocular pressure (IOP) was observed during the study period. Significant improvements in central macular thickness and visual acuity as well as tolerability and safety of the treatment were seen in our study. Further larger-scale studies are needed to ascertain the long-term benefits of the suprachoroidal triamcinolone acetonide.

Photodynamic therapy (PDT) using verteporfin (Visudyne®; Bausch + Lomb) is a treatment that is widely used to elicit cell and tissue death. In ophthalmology, PDT targets choroidal vascular abnormalities and induces selective occlusion of vessels. PDT was originally used in combination with full-dose verteporfin to treat neovascular age-related macular degeneration. Since the introduction of treatment with vascular endothelial growth factor receptor inhibitors, the clinical targets of PDT have shifted to other chorioretinal conditions, such as central serous chorioretinopathy, polypoidal choroidal vasculopathy, and choroidal hemangioma. In recent years, clinical studies have facilitated the optimization of treatment outcomes through changes in protocols, including the introduction of reduced treatment settings, such as PDT with half-dose verteporfin and half-fluence PDT. Here, we review PDT and its use for chorioretinal diseases from a practical perspective.

• Central serous chorioretinopathy
• Choroidal hemangioma
• Photodynamic therapy
• Polypoidal choroidal vasculopathy

• Macular edema
• management
• meta-analysis
• pharmacological agents
• systematic review
• treatment
• uveitis

• Humans
• Macular Edema/drug therapy
• Macular Edema/etiology
• Off-Label Use
• Tumor Necrosis Factor-alpha/antagonists & inhibitors
• Uveitis/complications

• CDRF-2014-05-057 Department of Health

The management of uveitis is challenging for most treating ophthalmologists. The treatment of uveitis often requires the use of high dose of systemic corticosteroid and immunosuppressive agents, which are almost always associated with potential side effects. Intravitreal medications have become a popular mode of drug administration in uveitis patients as they provide high volume of drug to the target tissues, eliminating the risk of systemic toxicity. There has been tremendous development in the intravitreal therapeutics over the last few years. With the advent of sustained-release technique, increasing patient compliance, biodegradable nature of the implant, and introduction of newer agents with better safety profile, the intravitreal medications have become more popular in recent years. This review presents evidence in the scientific literature supporting the use of intravitreal medications for the management of uveitis and its complications.

• Anti-vascular endothelial growth factor agents
• dexamethasone
• fluocinolone acetonide
• intravitreal agents
• methotrexate
• noninfectious uveitis
• sirolimus
• triamcinolone acetonide

• cystoid macular oedema
• diclofenac
• uveitis

• Dexamethasone
• intravitreal injection
• macular edema
• sustained release implant
• uveitis

• Evidence-Based Medicine
• Glucocorticoids/therapeutic use
• Humans
• Immunomodulation
• Immunosuppressive Agents/therapeutic use
• Risk Assessment
• Surveys and Questionnaires
• Time Factors
• Uveitis/diagnosis
• Uveitis/drug therapy
• Uveitis/physiopathology
• Visual Acuity/physiology

• ETM/351 Chief Scientist Office

• Dexamethasone Implant
• Intravitreal Injection
• Macular Edema
• Non-Infectious Uveitis

The purpose of this study was to report the functional and anatomical outcomes of a prospective study resulting from repeated dexamethasone intravitreal implants in patients with uveitic refractory macular edema.

Twelve eyes of 9 patients with intermediate and posterior noninfectious inflammatory uveitis complicated with refractory macular edema were regularly reviewed after a dexamethasone intravitreal implant. Patients were examined at baseline, 30, 90, 135, and 180 days with best-corrected visual acuity (BCVA), complete slit-lamp examination, intraocular pressure (IOP), optical coherence tomography, and fluorescein angiography. After 6 months of follow-up, eyes were reassessed to receive a second implant.

BCVA significantly improved when comparing the baseline values after the first and second implant (16.2 and 25.8 letters, respectively, 9.6 letters improvements, p<0.05). BCVA was better after the second implant compared to the first one throughout the follow-up, but without statistical significance. Mean central macular thickness (CMT) was 446.3±129.9 μm at baseline and was significantly reduced until day 135 (p<0.05). CMT reductions after the second injection showed a similar pattern, though differences were not statistically significant. Cataract progression was observed in 4 of 8 phakic eyes (50%) after the first implant, and in 2 of 3 phakic eyes following the second implant, with 1 eye requiring cataract surgery. One eye developed an IOP >30 mmHg 30 days after the second implant, treated topically.

Repeated dexamethasone intravitreal implants in uveitic patients with refractory macular edema can be used effectively in a clinical setting with an acceptable safety profile.

• dexamethasone
• intavitreal implant
• macular edema
• uveitis

• Adult
• Aged
• Aged, 80 and over
• Epiretinal Membrane/diagnosis
• Epiretinal Membrane/physiopathology
• Female
• Glaucoma, Open-Angle/diagnosis
• Glaucoma, Open-Angle/physiopathology
• Humans
• Intraocular Pressure
• Macular Edema/diagnosis
• Macular Edema/physiopathology
• Male
• Middle Aged
• Optic Nerve Diseases/diagnosis
• Optic Nerve Diseases/physiopathology
• Retinal Neurons/pathology
• Retrospective Studies
• Tomography, Optical Coherence
• Visual Acuity/physiology

We studied the clinical efficacy of Bevacizumab combined with argon green laser in treating fundus macular edema. From May 2009 to April 2013, 78 patients seeking treatment for macular edema in the First Affiliated Hospital of Nanchang University were enrolled in this study. Patients were randomly divided into two groups: i) The experimental group (n=39) and the control group (n=39). Patients in the experimental group were treated with Bevacizumab (Avastin^®) combined with argon green laser, and those in the control group were treated exclusively with argon green laser. Therapeutic effects were compared, and postoperative adverse reactions caused by both treatment methods were compared. Our results showed that, after treatment, the macular foveal thickness was reduced noticeably in both groups, while the therapeutic effect of combined treatment was more prominent. Patients in the experimental group gained the best-corrected visual acuity after one month of treatment, while patients in the control group achieved that after three months of treatment. We concluded that the use of Avastin^® combined with argon green laser was safe and effective. Visual acuity was improved obviously with minimum adverse reactions.

• Avastin
• argon green laser
• fundus macular edema

To report our experiences using Ozurdex, a biodegradable implant, containing 0.7 mg of dexamethasone in the treatment of noninfectious intermediate uveitis.

Retrospective study design.

We conducted a retrospective study of medical records of patients with noninfectious intermediate uveitis having either cystoid macular edema (CME) or vitritis who were not responsive to standard treatment and subsequently received Ozurdex implant from March 2011 to April 2013. The outcomes measured were best-corrected visual acuity, central retinal thickness (CRT), and vitreous haze score.

Paired t-test was used to test the significance of difference between quantitative variables. A P < 0.05 is taken to denote significant relationship.

Twenty eyes of 15 patients with mean age of 39.8 years who received Ozurdex implant were included in the study. The mean baseline visual acuity improved from 0. 666 logarithm of the minimum angle of resolution (logMAR) units to 0.479 logMAR units at 6 weeks after the implant. The mean CRT improved from 536.1 to 361.4 microns at 6 weeks postimplant both parameters were statistically significant. The ocular inflammation was controlled in almost all the patients. Cataract and raised intraocular pressure were documented complications.

Ozurdex implant is a promising treatment option and efficient in controlling the inflammation and CME in cases of noninfectious intermediate uveitis not responding to standard treatment.

To evaluate the safety, tolerability, and preliminary efficacy of suprachoroidal injection of triamcinolone acetonide (TA) in patients with noninfectious uveitis.

In this Phase 1/2 open-label clinical study, a single suprachoroidal injection of 4-mg TA in 100 μL was performed in the study eye of patients with noninfectious intermediate, posterior, or pan-uveitis, and follow-up obtained for 26 weeks.

Nine individuals with chronic uveitis were enrolled. There were 38 reported adverse events (AEs); most were mild or moderate in severity. Approximately half the AEs were ocular. The most common AE was reported by four subjects who experienced ocular pain at or near the time of the injection. All systemic AEs were unrelated to study drug. No steroid-related increases in intraocular pressure (IOP) were observed and no subject required IOP-lowering medication. All eight efficacy-evaluable subjects had improvements in visual acuity. Four subjects, who did not need additional therapy, had on average a greater than 2-line improvement in visual acuity through week 26. Three of four had macular edema at baseline, and two of three had at least a 20% reduction in macular edema at week 26.

The safety and preliminary efficacy data support further investigations of suprachoroidally administered TA as a therapeutic option for the treatment of noninfectious uveitis.

Targeted suprachoroidal administration of corticosteroid is a potential local route for the treatment of ocular inflammatory disease, which merits further investigation. (www.ClinicalTrials.gov, NCT01789320)

• drug delivery
• suprachoroidal space
• triamcinolone acetonide
• uveitis

• Central retinal thickness
• dexamethasone intravitreal implant
• macular edema
• uveitis
• visual acuity

• systematic review
• macular oedema
• macular edema
• uveitis
• management
• pharmacological agents
• meta-analysis

• Adrenal Cortex Hormones/therapeutic use
• Angiogenesis Inhibitors/therapeutic use
• Carbonic Anhydrase Inhibitors/therapeutic use
• Humans
• Immunosuppressive Agents/therapeutic use
• Macular Edema/drug therapy
• Macular Edema/etiology
• Systematic Reviews as Topic
• Treatment Outcome
• Tumor Necrosis Factor-alpha/antagonists & inhibitors
• Uveitis/complications
• Uveitis/drug therapy
• Meta-Analysis as Topic

• CDRF-2014-05-057 Department of Health
• G0600416 Medical Research Council
• Public Health Research Programme

• Ozurdex®
• central macular thickness
• cystoids macular oedema
• posterior uveitis

• Diabetic macular edema
• Diabetic retinopathy
• Dorzolamida
• Dorzolamide
• Edema macular diabético
• Fotocoagulación
• Photocoagulation
• Retinopatía diabética

• Adrenal Cortex Hormones/therapeutic use
• Angiogenesis Inhibitors/therapeutic use
• Anti-Inflammatory Agents/therapeutic use
• Drug Implants
• Drug Therapy, Combination
• Humans
• Immunosuppressive Agents/therapeutic use
• Intravitreal Injections
• Macular Edema/drug therapy
• Uveitis/drug therapy
• Vascular Endothelial Growth Factor A/antagonists & inhibitors
• Visual Acuity

Macular edema is one of the most common vision-threatening complications of uveitis noted in one third of patients with uveitis. The release of a number of inflammatory mediators induces retinal vascular hyperpermeability leading to uveitic macular edema (UME) which most commonly is of cystoid shape. Fluorescein angiography and non-invasive spectral-domain optical coherence tomography are standard procedures for diagnosis and follow-up of UME with some innovations such as scanning laser ophthalmoscope retro-mode imaging. Effective management of UME requires thorough understanding of the individual case. Proper control of intraocular inflammation is mandatory before targeting macular edema itself. Mainstay of treatment is immunosuppressive therapy with various drug delivery routes including topical, local subconjunctival, peribulbar and sub-Tenon’s, intravitreal and systemic. Clinical trials with biologics are under way to study the efficacy of these agents in suppressing intraocular inflammation and resolution of UME. Visual prognosis in UME depends on numerous factors. Younger age and better visual acuity at baseline are associated with more favorable visual outcome in most studies

• Intraocular inflammation
• Uveitic macular edema
• Fluorescein angiography
• Optical coherence tomography
• Corticosteroid therapy
• Drug delivery
• Clinical trials