Location Crucial to Corticosteroid Treatment for Uveitic Macular Edema

A new phase 3 clinicial study suggests that location matters when injecting corticosteroids into the eye to treat uveitic macular edema.

Uveitic macular edema, the fifth leading cause of blindness in the US, often does not respond to oral corticosteroids prescribed to minimize inflammation. In these cases, patients often require corticosteroid injections in or near the eye. There are 3 main options for injections to treat the uveitic macular edema which have not previously been compared head-to-head for efficacy.

If left untreated, uveitis can commonly lead to glaucoma, cataracts, optic nerve damage, retinal detachment and permanent vision loss.

The study’s chair, Douglas A. Jabs, MD, MBA, director of the Eye and Vision Research Institute at the New York Eye and Ear Infirmary of Mount Sinai, and professor of ophthalmology and medicine at the Icahn School of Medicine at Mount Sinai; told MD Magazine® that the study was designed because there was “previously no comparative data,” between periocular triamcinolone, intravitreal triamcinolone, and dexamethasone intravitreal implant.

“Different approaches and drugs [are] used, but without data as to which is best,” Jabs explained.

The trial, which began in 2015, included 192 patients throughout the US, Canada, Australia, and the United Kingdom. The patients were randomly assigned to receive 1 of the 3 treatments. The researchers followed up with the patients at 8 weeks after treatment, then again at 6 months after treatment.

Doctors assessed the patients for changes in central subfield thickness (CST) as well as improvement of macular edema, and best-corrected visual acuity (BCVA). All patients showed improvements in CST and BCVA throughout the follow up, but the patients who received 1 of the 2 intravitreal treatments showed greater improvements in macular edema and visual acuity than those who received the periocular triamcinolone.

There was a slightly elevated risk of intraocular pressure above or equal to 24 mm Hg in the patients treated with Intravitreal triamcinolone and Dexamethasone intravitreal implant as compared to those treated with the periocular triamcinolone. There was no difference in risk between the two intravitreal treatments. Jabs said, however, that there was “no significant difference in the rate of rise of IOP to >30 mm Hg.”

"The results of this study suggest that we should be shifting away from periocular injections and towards intravitreal injections of corticosteroids for uveitic macular edema, which should improve the management of patients with uveitis," Jabs explained in a statement.

Researchers still have work to do, because while more patients respond to the injections than to oral corticosteroids, some still do not respond to the injections. Other therapies must be evaluated and compared for these patients.

The study, “Periocular Triamcinolone vs. Intravitreal Triamcinolone vs. Intravitreal Dexamethasone Implant for the Treatment of Uveitic Macular Edema: The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial,” was published online in the journal of the American Academy of Ophthalmology.