[Treatment of macular edema: Comparison of efficacy and tolerability of subconjunctival triamcinolone injections, sub-tenon's triamcinolone injections and intravitreal dexamethasone implant].
The area of uveitis is related to numerous pathological entities. One of the main causes of decreased visual acuity in these patients is macular edema. One aspect of the treatment includes cortosteroids used peri- and intra-ocularly.


METHODS
The goal of our work was to estimate the criteria of efficacy (on improvement in visual acuity and macular edema, as well as time to recurrence) and safety (on intraocular pressure and cataract) of these various routes of administration of corticosteroid after a single injection. We compared patients treated with Ozurdex®versus subconjonctival triamcinolone versus sub-tenon's triamcinolone. This is a retrospective study conducted in 2 tertiary centers, the university medical center of Nantes and La Pitié-Salpêtrière hospital from November, 2011 to November, 2013.


RESULTS
At presentation, 25 % of the patients displayed VA better than 5/10. During follow-up, this proportion increased to 45 % at M1, 50 % at M3, 49 % at M6 and 48 % at the end of follow-up. There was no significant difference between the groups with respect to VA gain. The reductions in mean CMT compared with D0 were all statistically significant (improvement of one line in log-OCT). We observed an improvement in macular thickness of 88 % at M1, 86 % at M3, 61 % at M6 and 60 % at the end of follow-up, significant at each time, with no significant difference between the three groups. A comparison of time to anatomic vs. functional recurrence was performed, showing no difference. The largest increase in IOP was observed at M1, statistically different from the other time points.


CONCLUSIONS
Intra- and periocular injections should be considered as an adjuvant therapy, since the majority of the conditions in question require systemic treatment. They allow for increased intravitreal concentrations with fewer systemic effects.


CONCLUSIONS
We demonstrated neither any true superiority of any of the 3 treatments nor any difference in tolerability between the 3 groups.
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France. Electronic address: clemence.carbonniere@laposte.net.
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Carbonnière
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Couret
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Blériot
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Lebreton
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Massé
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Le Meur
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Lebranchu
CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Weber
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva; D004343:Drug Implants; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D056965:Injections, Intraocular / Q000009:adverse effects; D008269:Macular Edema / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects
D004343:Drug Implants; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
Corticoids; Corticoïdes; Intra-vitreous; Intra-vitréenne; Macular edema; Ozurdex(®); Sous-conjonctivale; Sous-ténonienne; Sub-tenonian; Subconjunctival; Triamcinolone; Uveitis; Uvéite; Œdème maculaire