Clinical Study On Intravitreal Injection Of Triamcinolone Acetonide Or Dexamethason Intravitreal Implant For Refractory Non-infectious Panuveitis

Objective: To evaluate the effectiveness of intravitreal injection of triamcinolone acetonide or dexamethasone intravitreal implant for refractory non-infectious panuveitis.Methods: Patients with non-infectious panuveitis,who had previously received long-term systemic and local corticosteroid treatment but ineffectiveness,had been treated with intravitreal injection of triamcinolone acetonide or dexamethasone intravitreal implant in our hospital from August 2017 to August 2019.Outcome measures include the best corrected visual acuity(BCVA),intraocular pressure(IOP),center retinal thickness(CRT)and vitreous haze score(VH),to evaluate the effect after 2 weeks,1,2,3,4 and 6 month treatment.Results: The BCVA,VH and CRT were significantly improved after intravitreal injection of triamcinolone acetonide or dexamethasone intravitreal implant.The dexamethasone intravitreal implant group improved significantly after 2 weeks of treatment.During the follow-up period,only two eyes had IOP increasing ≥21mm Hg.All IOP increasing were transient and effectively managed with two topical hypotensive eye drops and no surgery needed,and no cataract developing was found.In the triamcinolone acetonide group,the improvement was relative slowly,and the non-infectious intraocular inflammation occurred 1-3 days after 21 injections(61.8%),which seriously affected vision.Twelve eyes(35.3%)had IOP increasing ≥21mm Hg,and two eyes were failed in drug therapy and needed anti-glaucoma surgery.Cataract surgery was performed in 7 eyes of 5 cases.No patient had serious complications,such as infective endophthalmitis,vitreous hemorrhage,retinal detachment or macular hole.Conclusion: Intravitreal injection of triamcinolone acetonide or dexamethasone may effectively control refractory non-infectious panuveitis,improve vision and reduce the opacity of anterior chamber and vitreous,and reduce central retinal thickness.Intravitreal injection of triamcinolone acetonide is prone to non-infectious intraocular inflammation,and the opaque white drug particles in the vitreous body may affect vision.Intravitreal injection of dexamethasone intravitreal implant is effective and safe,with less side effects,and is worthy of clinical development.