Abstract

SO.20.07

Comparison of oral prednisolone versus intravitreal injection of triamcinolone for patients with noninfectious uveitis undergoing cataract surgery: a prospective randomized study

Heiligenhaus A. Roesel M., Koch J. M., Heinz C.
Department of Ophthalmology, St. Franziskus-Hospital, Muenster

Objective: In this study an intraoperative intravitreal triamcinolone acetonide injection was compared with oral prednisolone in the treatment of inflammation after cataract surgery in patients with noninfectious uveitis.
Methods: Prospective, randomized study with patients with noninfectious uveitis, who underwent phacoemulsification with implantation of an acrylic IOL. After surgery, patients were randomized to receive either a 4-week oral prednisone (group 1, n=20) or intraoperative 4mg triamcinolone acetonide (TA) intravitreal injection (group 2, n=20). All patients received additional 1% prednisolone acetate eyedrops. Follow-up was scheduled at 1, 3 and 6 months postoperatively. At each time point, best-corrected visual acuity (BCVA), AC cells, laser-flare photometry (LFM; Kowa FC 100, Japan), IOL deposits, and posterior capsule opacification (PCO) were determined. The cystoid macular edema (CME) was studied by fluorescein angiography and OCT.
Results: At time of surgery, uveitis was inactive in all patients (mean age, 51±14 yrs, m±SD). The anatomic type of uveitis, immunosuppression, disease association and surgical manoeuvres did not differ between the groups. BCVA at 6 month increased in both groups, and did not differ significantly between the groups. The number of AC cells and the LFM-levels at 1 and 3 month in group 1 were higher than in group 2. Cell deposits on the anterior IOL surface at 1 month were more often in group 1 than in group 2. The PCO rates and the number of Nd:YAG laser capsulotomies did not differ between the groups. Improvement of CME was noted at 1 and 3 month in group 2, but not in group 1.
Conclusions: An intraoperative 4mg triamcinolone acetonide intravitreal injection demonstrated a clinically better therapeutic response compared with a 4-week course of oral prednisolone in controlling postoperative inflammation and improving CME after cataract surgery in patients with noninfectious uveitis.

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