Intraoperative use of intravitreal triamcinolone in uveitic eyes having cataract surgery: pilot study.
OBJECTIVE
To report the outcomes of cataract extraction with intraoperative intravitreal triamcinolone (IVTA) in eyes with a history of posterior uveitis.


METHODS
Moorfields Eye Hospital Uveitis Service, London, United Kingdom.


METHODS
Nineteen eyes of 17 patients with posterior uveitis thought to require systemic corticosteroid prophylaxis for cataract surgery were included. The use of systemic corticosteroids at the time of surgery would have been problematic in 7 of the patients, who had a history of systemic hypertension. Three of the 7 patients were also diabetic. All patients were not happy about using oral corticosteroids.


RESULTS
Median visual acuity 1 day after surgery was 20/40 (range 20/20 to counting fingers). At final follow-up (mean 25.2 months; range 7 to 41 months), 17 eyes (89.5%) eyes achieved visual acuity of 20/40 or better; 2 eyes failed to achieve a final visual acuity of 20/40 or better, 1 as a result of optic atrophy and the other as a result of macular edema. No patient lost acuity and no eye developed macular edema within 4 months of surgery. Intraocular pressure elevation occurred after surgery in 3 eyes; all were controlled by topical medication that was discontinued after 3 months. One patient developed severe intraocular inflammation after surgery that resolved with intensive topical corticosteroid therapy within 1 week.


CONCLUSIONS
Cataract extraction by phacoemulsification with concurrent IVTA appears a useful treatment option. Targeted delivery of corticosteroid is achieved without the risks of systemic corticosteroid prophylaxis. The incidence of postoperative macular edema was markedly reduced. Levels of visual acuity after cataract surgery, similar to those in eyes without uveitis, were achieved in eyes with posterior uveitis.
Okhravi
Narciss
N
Medical Retina and Uveitis Service, Moorfields Eye Hospital, London, United Kingdom. narciss.okhravi@moorfields.nhs.uk
Morris
Ainsley
A
Kok
Howe Sen
HS
Menezo
Victor
V
Dowler
Jonathan G F
JG
Hykin
Phillip G
PG
Lightman
Sue
S
D000328:Adult; D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007429:Intraocular Pressure; D007430:Intraoperative Care; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D015866:Uveitis, Posterior / Q000188:drug therapy*; D014792:Visual Acuity; D014822:Vitreous Body
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide