TY - JOUR
T1 - Periocular corticosteroid injections in uveitis
T2 - Effects and complications
AU - Sen, H. Nida
AU - Vitale, Susan
AU - Gangaputra, Sapna S.
AU - Nussenblatt, Robert B.
AU - Liesegang, Teresa L.
AU - Levy-Clarke, Grace A.
AU - Rosenbaum, James T.
AU - Suhler, Eric B.
AU - Thorne, Jennifer E.
AU - Foster, C. Stephen
AU - Jabs, Douglas A.
AU - Kempen, John H.
N1 - Publisher Copyright:
© 2014 American Academy of Ophthalmology.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Purpose To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders.Design Multicenter, retrospective cohort study.ParticipantsA total of 914 patients (1192 eyes) who had received ≥1 periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States.Methods Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers.Main Outcome Measures Control of inflammation, improvement of visual acuity (VA) to ≥20/40, improvement of VA loss attributed to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery.Results Among 914 patients (1192 eyes) who received ≥1 periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% (95% CI, 69.1-76.3) of the eyes achieved complete control of inflammation and 49.7% (95% CI, 45.5-54.1) showed an improvement in VA from <20/40 to ≥20/40. Among the subset with VA <20/40 attributed to ME, 33.1% (95% CI, 25.2-42.7) improved to ≥20/40. By 12 months, the cumulative incidence of ≥1 visits with an intraocular pressure of ≥24 mmHg and ≥30 mmHg was 34.0% (95% CI, 24.8-45.4) and 15.0% (95% CI, 11.8-19.1) respectively; glaucoma surgery was performed in 2.4% of eyes (95% CI, 1.4-3.9). Within 12 months, among phakic eyes initially ≥20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2% (95% CI, 15.9-25.6); cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes (95% CI, 11.1-17.2).Conclusions Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, VA improved in one half of the patients at some point within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.
AB - Purpose To evaluate the benefits and complications of periocular depot corticosteroid injections in patients with ocular inflammatory disorders.Design Multicenter, retrospective cohort study.ParticipantsA total of 914 patients (1192 eyes) who had received ≥1 periocular corticosteroid injection at 5 tertiary uveitis clinics in the United States.Methods Patients were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained at every visit via medical record review by trained reviewers.Main Outcome Measures Control of inflammation, improvement of visual acuity (VA) to ≥20/40, improvement of VA loss attributed to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery.Results Among 914 patients (1192 eyes) who received ≥1 periocular injection during follow-up, 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% (95% CI, 69.1-76.3) of the eyes achieved complete control of inflammation and 49.7% (95% CI, 45.5-54.1) showed an improvement in VA from <20/40 to ≥20/40. Among the subset with VA <20/40 attributed to ME, 33.1% (95% CI, 25.2-42.7) improved to ≥20/40. By 12 months, the cumulative incidence of ≥1 visits with an intraocular pressure of ≥24 mmHg and ≥30 mmHg was 34.0% (95% CI, 24.8-45.4) and 15.0% (95% CI, 11.8-19.1) respectively; glaucoma surgery was performed in 2.4% of eyes (95% CI, 1.4-3.9). Within 12 months, among phakic eyes initially ≥20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2% (95% CI, 15.9-25.6); cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes (95% CI, 11.1-17.2).Conclusions Periocular injections were effective in treating active intraocular inflammation and in improving reduced VA attributed to ME in a majority of patients. The response pattern was similar across anatomic locations of uveitis. Overall, VA improved in one half of the patients at some point within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.
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U2 - 10.1016/j.ophtha.2014.05.021
DO - 10.1016/j.ophtha.2014.05.021
M3 - Article
C2 - 25017415
AN - SCOPUS:84908477716
SN - 0161-6420
VL - 121
SP - 2275
EP - 2286
JO - Ophthalmology
JF - Ophthalmology
IS - 11
ER -