Comparison Between Intravitreal Ranibizumab Injection, Corticosteroid Implants and Intravitreal Triamcinolone Acetonide injection In Treatment of Noninfectious Uveitic Macular Edema

Abstract

Background: Uveitis is a broad term for inflammation involving the eye. It is classified according to the location of the inflammatory process either anterior, intermediate, posterior or panuveitis. Uveitis can be secondary to an infectious etiology, such as tuberculosis, toxocara canis, toxoplasmosis, herpes virus, Lyme, and syphilis. Purpose: comparing the efficacy and safety of intravitreal ranibizumab injection, corticosteroid implants and Intravitreal triamcinolone acetonide (IVTA) injection in treatment of noninfectious uveitic macular edema. Patients and Methods: A prospective study was conducted in Al-Azhar University Hospitals (El-Hussein and BabElsheryia Hospitals). A total of 60 eyes of 45 uveitic patients were recruited in this study. First group; 20 eyes undergo intravitreally injection with ranibizumab 0.5 mg (0.05 ml), one dose per month (six doses). Second group; 20 eyes undergo corticosteroid implants. Third group 20 eyes undergo IVTA injection. Results: All patients included in this study completed the period of follow up (six months) in group 1 Visual acuity (VA) improved and central macular thickness (CMT) decreased slightly but not significantly after 1 month to 1.35 ± 0.25 and 365.3 ±185.5\u2009μM, respectively. In group 2; VA improved and CMT decreased after 1 month to 1.75 ± 0.2 and 470.45 ± 175.20\u2009μM, respectively. In group 3; VA improved and CMT decreased slightly after 1 month to 2.15 ± 0.22 and 460.45 ± 185.45\u2009μM, respectively, an increase of intra ocular pressure (IOP) between 6 mmHg and 15 mmHg was maintained in 16 of 20 eyes (80%) at 1 months and was maintained in 4 of 20 eyes at 3 months (20%). Conclusion: Intravitreal injection can be used as a single therapy to treat uveitic ME secondary to noninfectious uveitis. With a variety of intravitreal therapeutic agents available for treatment of uveitic ME in this study (Intravitreal ranibizumab injection, corticosteroid implants and IVTA) and each drug having its own advantages and disadvantages, the final treatment should be individualized based on the severity of disease, risk /benefit ratio of each therapy and choice of the patient.