title: Periocular corticosteroid injections in uveitis: effects and complications.
abstract: OBJECTIVE
  To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders.
  
  
  METHODS
  Multicenter, retrospective cohort study.
  
  
  METHODS
  A total of 914 patients (1192 eyes) who had received ≥ 1 periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States.
  
  
  METHODS
  Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers.
  
  
  METHODS
  Control of inflammation, improvement of visual acuity (VA) to ≥ 20/40, improvement of VA loss attributed to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery.
  
  
  RESULTS
  Among 914 patients (1192 eyes) who received ≥ 1 periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤ 6 months, 72.7% (95% CI, 69.1-76.3) of the eyes achieved complete control of inflammation and 49.7% (95% CI, 45.5-54.1) showed an improvement in VA from <20/40 to ≥ 20/40. Among the subset with VA <20/40 attributed to ME, 33.1% (95% CI, 25.2-42.7) improved to ≥ 20/40. By 12 months, the cumulative incidence of ≥ 1 visits with an intraocular pressure of ≥ 24 mmHg and ≥ 30 mmHg was 34.0% (95% CI, 24.8-45.4) and 15.0% (95% CI, 11.8-19.1) respectively; glaucoma surgery was performed in 2.4% of eyes (95% CI, 1.4-3.9). Within 12 months, among phakic eyes initially ≥ 20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2% (95% CI, 15.9-25.6); cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes (95% CI, 11.1-17.2).
  
  
  CONCLUSIONS
  Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, VA improved in one half of the patients at some point within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.
authors.affiliation: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland. Electronic address: senh@nei.nih.gov.
authors.forename: H Nida
authors.initials: HN
authors.lastname: Sen
authors.affiliation: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
authors.forename: Susan
authors.initials: S
authors.lastname: Vitale
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Sapna S
authors.initials: SS
authors.lastname: Gangaputra
authors.affiliation: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nussenblatt
authors.affiliation: Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Liesegang
authors.affiliation: Laboratory of Immunology, National Eye Institute, Bethesda, Maryland; Tampa Bay Uveitis Center, Tampa, Florida.
authors.forename: Grace A
authors.initials: GA
authors.lastname: Levy-Clarke
authors.affiliation: Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Department of Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.affiliation: Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Veterans' Affairs Medical Center, Portland, Oregon.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Suhler
authors.affiliation: Department of Ophthalmology, The Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
authors.affiliation: Massachusetts Eye Research and Surgery Institute, Cambridge, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: C Stephen
authors.initials: CS
authors.lastname: Foster
authors.affiliation: Department of Epidemiology, Center for Clinical Trials, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York; Department Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: Department of Ophthalmology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: John H
authors.initials: JH
authors.lastname: Kempen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide