Sub-Tenon's triamcinolone bridging to adalimumab therapy in refractory noninfectious uveitic macular edema

Noninfectious uveitic macular edema (UME) is a major cause of visual impairment and remains challenging in refractory cases. Although adalimumab (ADA) is an effective biologic therapy, its delayed onset may limit early disease control, suggesting a potential role for bridging strategies such as local corticosteroid injection. This study compared ADA monotherapy with ADA combined with sub-Tenon's triamcinolone acetonide (STTA) bridging therapy in refractory noninfectious UME.

In this retrospective longitudinal cohort study, 30 patients (44 eyes) with refractory noninfectious UME treated with ADA (2015-2025) were included. Patients received either ADA monotherapy or ADA with STTA bridging therapy. Outcomes included time to improvement (≥ 20% reduction in central subfield thickness (CST) with reduced cystoid spaces), relapse after resolution, longitudinal CST changes, best-corrected visual acuity (BCVA, LogMAR), and intraocular pressure (IOP). Time-to-event analyses were performed using Cox regression, and Longitudinal data using generalized estimating equation models adjusted for baseline covariates.

Bridging therapy was associated with a shorter time to improvement (log-rank p = 0.008; HR 2.850, 95% CI 1.402-5.794; p = 0.004). Adjusted analyses showed greater visual improvement in the bridging group at 12 months (difference 0.307 LogMAR; p < 0.001) and at 15, 24, and 36 months (p < 0.05). Greater CST reductions were observed at 3, 18, 21, and 36 months (p < 0.05). Relapse risk did not differ significantly (HR 0.711, 95% CI 0.155-3.272; p = 0.662). IOP changes were generally comparable.

ADA combined with STTA bridging therapy was associated with earlier anatomical improvement and additional visual benefits compared with ADA monotherapy, without increased relapse risk.