Uveitis: Intravitreales Triamcinolon bei zystoidem Makulaödem

Abstract

Cystoid macular edema (CME) is the most frequent cause of severe loss of visual acuity in uveitis. Among the systemic corticosteroids and immunosuppressive agents, the local use of intravitreal triamcinolone acetate (TA) is evaluated. Intravitreal injections of 10 mg TA were performed in ten eyes of six patients with persisting uveitic CME in spite of systemic cortisone or immunosuppressive therapy. The mean follow-up time was 9.8 months (range: 3-18). Visual acuity increased from 0.58 logMAR to 0.21 logMAR. In two eyes of one patient, repeated intravitreal injections of TA were necessary. Side effects included a increase of intraocular pressure (IOP) up to 25 mmHg or more in 30% of the eyes. In these three eyes, IOP was successfully controlled by local antiglaucomatous therapy (IOP < or = 20 mmHg). The dosage of systemic steroids had to be augmented in two eyes. In no patient was injection-related endophthalmitis, vitreous hemorrhage or retinal detachment observed. Intravitreal TA is an effective local therapy for CME due to uveitis without systemic side effects. It cannot replace the systemic basal therapy of uveitis, since the long-term effects are limited. It can be used as a bridging therapy until a systemic immunosuppression is started. It may, furthermore, be a therapeutic option when side effects of immunosuppressive agents are expected.