Efficacy and safety of intravitreal and periocular injection of corticosteroids in noninfectious uveitis: a systematic review

Uveitis is among the leading causes of visual loss in the working age population. In noninfectious uveitis, corticosteroids are the first line therapy. We sought to review systematically the evidence regarding the regional corticosteroid delivery modalities in the treatment of noninfectious uveitis. A 5-database search (Pubmed, ISI Web of Science, Cochrane, ClinicalTrials.gov, and Scopus) was performed from inception to February, 2021. Nineteen studies with a total of 1,935 eyes of 1,753 patients were selected from 8,922 abstracts retrieved by the initial search. The most frequently compared regimens were intravitreal triamcinolone acetonide injection and orbital floor triamcinolone acetonide injection (2 studies), intravitreal triamcinolone acetonide injection and posterior sub-Tenon triamcinolone acetonide injection (2 studies), and posterior sub-Tenon triamcinolone acetonide injection with the intravitreal dexamethasone implant (2 studies). Our results show that the intravitreal injection of corticosteroids is more effective, but is associated with more adverse events, than periocular injection. Some evidence supports the use of subconjunctival triamcinolone acetonide over intravitreal/periocular triamcinolone acetonide. Moreover, the overall results of 0.59 mg dosage of the intravitreal fluocinolone acetonide implant were superior to those from the 2.1 mg dose. The evidence, however, is not robust, and further studies with standardized outcomes are warranted.