Treatment Duration and Side Effect Profile of Long-Term Use of Intravitreal Preservative-Free Triamcinolone Acetonide in Uveitis

Abstract

Noninfectious uveitis has been treated historically with corticosteroid therapy in varying doses and routes. Triesence, a preservative-free sterile formulation of triamcinolone acetonide, has been used in a wide spectrum of ocular pathologies, but there have been few large studies validating its dosing or detailing long-term side effects in uveitic disease. The primary aim of this study was to describe the relative duration of action and side effects of 2 doses of preservative-free intravitreal triamcinolone acetonide (PF-IVTA) in uveitis. Retrospective, comparative consecutive case series. Charts of all patients receiving PF-IVTA (2mg or 4mg) in a defined time period (2012-2014) at the Cole Eye Institute were examined for patient demographics, time to treatment failure (TTF), use of systemic immunosuppression, use of intraocular pressure-lowering therapies, date of cataract surgery and glaucoma filtration surgery, and adverse events. The final data set examined 514 injections in 214 eyes. Mean duration of follow-up was 1.5 years. There was similar demographic distribution between eyes that received 2mg PF-IVTA only and eyes that received a combination of 4+ 2mg PF-IVTA. No statistically significant difference in TTF between injection dosages was observed. There was a higher incidence of glaucoma filtering surgery and cataract surgery in eyes that received 4+ 2mg PF-IVTA as well as a shorter time to glaucoma surgery, when compared to eyes that received 2mg PF-IVTA alone. This retrospective study supports that 2mg PF-IVTA displayed noninferior treatment duration to 4mg PF-IVTA, and may carry a significantly lower side-effect profile of cataract development and glaucoma filtering surgery.