April 2019

NEWS

Research Highlight
Intravitreal vs. periocular approaches for uveitic macular edema


by Maxine Lipner EyeWorld Senior Contributing Writer


Intravitreal injection of triamcinolone acetonide in the eye
Source: Mara Berrocal, MD

Injections of corticosteroids directly into the eye are superior to those placed adjacent to the eye for treating uveitic macular edema, study1 results published in Ophthalmology show, according to Jennifer Thorne, MD, PhD.
The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial examined the effectiveness of three corticosteroid treatment approaches for patients with uveitic macular edema: regional therapy with periocular triamcinolone injections, intravitreal triamcinolone injections, and an intravitreal dexamethasone implant.
While these treatments are three of the more commonly utilized modalities for uveitic macular edema, there is a relative paucity of head-to-head comparisons. “The idea behind the trial was to compare these three modalities for the treatment of uveitic macular edema in terms of effectiveness and safety,” Dr. Thorne said.
The trial included patients who had noninfectious uveitis complicated by macular edema. It did not matter whether the uveitis was active or inactive at the time of randomization, she said, adding that in order to qualify, patients needed be on a stable amount of medication, have OCT measurements outside the normal range, and not have severe glaucoma.
The primary outcome that investigators sought was the proportion of improvement of the central subfield thickness from baseline to 8 weeks after injection as assessed with an OCT measurement graded by a masked reader. “Secondary outcomes included 20% or greater improvement in central subfield thickness and resolution of macular edema over the 24-week study follow-up,” Dr. Thorne said.
As part of the study, investigators also looked at improvement in BCVA and followed the IOP measurement to look for ocular hypertension, development of glaucoma, and need for glaucoma medications to control eye pressure, Dr. Thorne noted.

Comparing outcomes

Investigators found that at the 8-week outcome visit all three treatments improved macular edema, Dr. Thorne reported. “All three were effective at reducing macular edema from baseline, but when we looked at the proportion of improvement, both intravitreal triamcinolone and intravitreal dexamethasone were more effective than periocular triamcinolone at 8 weeks. Additionally, the dexamethasone implant was non-inferior to intravitreal triamcinolone in the reduction of uveitic macular edema.”
The intravitreal approaches were also more effective in terms of secondary outcomes including 20% or greater reduction in macular edema, resolution of macular edema, and proportion of improvement of BCVA. “All of those outcomes supported the primary outcome,” Dr. Thorne said.
From a visual perspective, all the patients improved. When investigators analyzed the data on each treatment group, they saw an improvement in BCVA from baseline. Once again all three were effective options, however, there were some differences. “The periocular group at 8 weeks improved by about one line of vision, and the intravitreal groups improved another line over and above that,” she said. While these differences were statistically significant, differences between the two intravitreal groups were not significant.
Investigators also found that rates of elevation in eye pressure were essentially similar across the groups, Dr. Thorne reported. “Severe eye pressure rises were uncommon, and no cases of glaucoma surgery occurred,” she said, adding, however, that the trial was short.

Practical implications

Clinically speaking, Dr. Thorne thinks the study results substantiate the idea of using the intravitreal approach when possible. “When the average patient with uveitic macular edema comes in, if you’re considering intravitreal versus periocular, this study supports using intravitreal earlier in your treatment regimen rather than going with periocular triamcinolone first,” she said.

About the doctor
Jennifer Thorne, MD, PhD
Cross Family Professor of Ophthalmology and Epidemiology
Wilmer Eye Institute
Johns Hopkins University
School of Medicine
Baltimore

Reference

1. Thorne JE, et al. Periocular triamcinolone vs. intravitreal triamcinolone vs. intravitreal dexamethasone implant for the treatment of uveitic macular
edema: The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial. Ophthalmology. 2019;126:283–295.

Financial interests
Thorne
: Allergan

Contact information
Thorne
: jthorne@jhmi.edu

Intravitreal vs. periocular approaches for uveitic macular edema Intravitreal vs. periocular approaches for uveitic macular edema
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