Intravitreal Triamcinolone Acetonide in Chronic Refractory Uveitis

To evaluate the effect of intravitreal triamcinolone acetonide injection for management of chronic refractory uveitis in terms of inflammation, visual acuity and macular thickness. This interventional case series was conducted on uveitic eyes with no remission despite proper administration of periocular and/or systemic steroids. After systemic and rheumatologic evaluations and confirmation of non-infectious nature of uveitis, 18 eyes of 10 patients underwent intravitreal injection of 4 mg triamcinolone acetonide. Changes in intraocular inflammation, best-corrected visual acuity (BCVA), intraocular pressure (IOP) and macular thickness on optical coherence tomography were assessed during six months of follow-up. Mean BCVA increased from a baseline value of 0.81±0.29 to 0.35±0.33 LogMAR one week and to 0.17±0.07 LogMAR one month after the injection, respectively (P<0.001). It decreased thereafter to 0.46±0.3 LogMAR at the sixth month visit, but was still significantly greater than the baseline value (P<0.001). Mean IOP reached its maximum level one month post-injection with an increase of 7.36±0.48 mmHg compared to the baseline value, however only two eyes had IOP>22 mmHg which were successfully controlled using topical IOP-lowering medication. Mean central macular thickness decreased from 339.8±24.1 m to its minimum value (197.18±12.7 m) one month after the injection (P<0.001) and then increased to 203.57±9.06 m at sixth month visit, still less than the baseline value (P< 0.001). Intravitreal injection of triamcinolone acetonide in chronic refractory uveitis improves visual acuity and decreases central macular thickness which is sustained for at least six months. The only noticeable complication, transient IOP elevation can be controlled with topical medications.