Periocular triamcinolone for prevention of macular edema after plaque radiotherapy of uveal melanoma: a randomized controlled trial.
OBJECTIVE
To determine the efficacy and safety of periocular triamcinolone acetonide (40 mg) for the prevention of macular edema in patients undergoing plaque radiotherapy for uveal melanoma.


METHODS
Prospective, randomized, controlled clinical trial.


METHODS
One-hundred sixty-three patients with newly diagnosed uveal melanoma undergoing iodine 125 plaque radiotherapy were entered into the study. Fifty-five patients were randomized to the control group and 108 to the triamcinolone group. Eighteen-month data were available for 143 (88%) of the 163 patients.


METHODS
Periocular injection of triamcinolone acetonide (40 mg in 1 ml) at the time of plaque radiotherapy and 4 months and 8 months later. Optical coherence tomography was performed at each patient evaluation.


METHODS
Optical coherence tomography-evident macular edema, moderate vision loss, and poor final visual acuity.


RESULTS
Optical coherence tomography-evident macular edema occurred significantly less often in the triamcinolone group compared with the control group up to 18 months after plaque radiotherapy (hazard estimate, 0.45; 95% confidence interval, 0.19-0.70; P = 0.001). At the 18-month follow-up, moderate vision loss (loss of 3 lines or more of best-corrected visual acuity [BCVA]) and severe vision loss (BCVA <5/200 Snellen) occurred significantly less frequently in the triamcinolone group than in the control group (31% vs. 48% [P = 0.039] and 5% vs. 15% [P = 0.048], respectively). Rates of elevated intraocular pressure and cataract progression were similar in both groups.


CONCLUSIONS
Periocular triamcinolone is beneficial in reducing the risk of macular edema up to 18 months after plaque radiotherapy for uveal melanoma and significantly reduces the risk of moderate vision loss and poor visual acuity in these patients.
Horgan
Noel
N
Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Shields
Carol L
CL
Mashayekhi
Arman
A
Salazar
Pedro F
PF
Materin
Miguel A
MA
O'Regan
Myra
M
Shields
Jerry A
JA
D001918:Brachytherapy; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008269:Macular Edema / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014604:Uveal Neoplasms / Q000532:radiotherapy*; D014792:Visual Acuity
D005938:Glucocorticoids; D007457:Iodine Radioisotopes; D014222:Triamcinolone Acetonide