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DR.RASHI JAIN/PROF. MANOJ SHUKLA/DR.SIMI.ZAKA-UR-RAB Code No.FP 511

INTRAVITREAL VERSUS POSTERIOR SUBTENONS TRIAMCINOLONE ACETONIDE INJECTION IN POSTERIOR UVEITIS AND CHRONIC PANUVEITIS. DR.RASHI JAIN/PROF. MANOJ SHUKLA/DR.SIMI.ZAKA-UR-RAB Code No.FP 511. INTRODUCTION. Posterior uveitis has great potential for visual morbidity and visual loss.

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DR.RASHI JAIN/PROF. MANOJ SHUKLA/DR.SIMI.ZAKA-UR-RAB Code No.FP 511

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  1. INTRAVITREAL VERSUS POSTERIOR SUBTENONS TRIAMCINOLONE ACETONIDE INJECTION IN POSTERIOR UVEITIS AND CHRONIC PANUVEITIS DR.RASHI JAIN/PROF. MANOJ SHUKLA/DR.SIMI.ZAKA-UR-RAB Code No.FP511

  2. INTRODUCTION • Posterior uveitis has great potential for visual morbidity and visual loss. • Corticosteroids are regarded as principal therapy. • These can be given topically, systemically or by means of periocular injections. • Systemic drugs are beneficial but have side effects which outweigh these. • Periocular and intravitreal injections deliver drug directly to target tissue without extraocular side effects.

  3. AIMS AND OBJECTIVES • To clinically evaluate and compare the therapeutic effects of intravitreal and posterior subtenons triamcinolone acetonide injection in posterior uveitis and chronic panuveitis of varied etiology . • To observe complications if any associated with intravitreal and posterior subtenons triamcinolone acetonide injection in the treatment of posterior uveitis and chronic panuveitis.

  4. MATERIALS AND METHODS • Group of 40 patients (50 Eyes) were enrolled in this study. TOTAL EYES (50) Gp I(22) IVTA Gp II(28) PSTA

  5. All examinations were done before the injection and then at 1 day,1 week, 3 weeks, 6 weeks and 3 months follow up respectively. 1)VISUAL ACUITY: Both uncorrected and best corrected visual acuity were recorded using Snellen charts. 2)SLIT LAMP BIOMICROSCOPY: Anterior chamber reaction and +90D examination 3)FUNDUS EXAMINATION: Using direct and indirect ophthalmoscopy. Vitreous haze was classified according to visibility of fundus details.

  6. 4) INTRAOCULAR PRESSURE : Using Applanation tonometry 5) FUNDUS FLUORESCEIN ANGIOGRAPHY Was done at baseline and at 6-8 weeks of follow up to evaluate the effects of triamcinolone acetonide .

  7. RESULTS 1.VISUAL ACUITY Both IVTA and PSTA were equally efficacious in all the follow ups (1 day, 1 week, 3 weeks, 6 weeks and 3 months). The difference in mean change in visual acuity (Log MAR units) was statistically insignificant(p>0.05)

  8. 2. CLINICAL EXAMINATION • In Group I and II there was decrease in the inflammation of vitreous in both groups. At the end of 3 months: a)IVTA:66% patients had no inflammation b)PSTA:67% patients had no inflammation 3. FUNDUS EXAMINATION • There was similar results in both groups. Fundus lesions showed healing and resolution of macular edema (if any)

  9. 4.FUNDUS FLUORESCEIN ANGIOGRAPHY a)Decrease in hyperfluorescence b)No leakage in macular area 5.INTRAOCULAR PRESSURE a)IVTA: Statistically significant increase in IOP at 1 and 3 weeks follow up(p<0.05) b)PSTA: Statistically significant increase in IOP at 6 weeks(p<0.05) but not clinically significant

  10. At the end of 6 weeks and 3 months the difference in IOP in the two groups was statistically insignificant(p>0.05). • The rise in IOP in patients receiving IVTA was controlled with antiglaucoma medications.

  11. CONCLUSION • Both intravitreal (IVTA) and posterior subtenon triamcinolone acetonide (PSTA) are equally effective means of modality of treatment in cases of posterior uveitis and chronic panuveitis. • Rate of complications in form of raised IOP is higher in IVTA than PSTA, but was controlled with antiglaucoma drugs. No other complications were seen.

  12. REFERENCES 1)Choudhry S, Ghosh S. Intravitreal and posterior subtenontriamcinoloneacetonide in idiopathic bilateral uveitic macular oedema. Clin Exp Ophthalmol. 2007; 35 (8):713–8. (2)Atmaca LS, Yalcindag FN, Ozdemir O. Intravitrealtriamcinoloneacetonide in the management of cystoid macular edema in Behcet’s disease. Graefes Arch Clin Exp Ophthalmol. 2007; 245 (3):451–6. 3)Jonas JB, Degenring RF, Kreissig I. Intraocular pressure elevated after intravitrealtriamcinoloneacetonide injection.Ophthalmology2005; 112:593–22. 4)Tanner V, Kanski JJ, Frith PA. Posterior sub-Tenonstriamcinolone injections in the treatment of uveitis. Eye (Lond). 1998;12(4):679-85. 5)TuğbaGoncu, ŞengülÖzdek, GökhanGurelik, BeratiHasanreisoglu.The Effectivity and Complications of Posterior SubtenonTriamcinolone Injection for the Treatment of Uveitis. Journal of Retina-Vitreous 2007; 15(1):35-39.

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