Intraocular Pressure Elevation After Suprachoroidal Triamcinolone Acetonide in Noninfectious Uveitis: An IRIS®...

To evaluate the incidence of intraocular pressure (IOP) elevation and glaucoma-related complications after suprachoroidal triamcinolone acetonide (SCS-TA) injection in patients with noninfectious uveitis (NIU) using real-world data from the IRIS® Registry.

Retrospective propensity score matched (PSM) cohort study.

Adults with NIU recorded in the American Academy of Ophthalmology IRIS® Registry who received SCS-TA, a dexamethasone intravitreal implant (DEX), or systemic immunosuppressive therapy without local corticosteroid (CS) treatment.

Eyes treated with SCS-TA were matched 1:1:1 with eyes receiving DEX or systemic therapy controls using PSM based on baseline demographics and clinical characteristics. One eye per patient was included. Time-to-event analyses of IOP elevation and glaucoma surgery over the 12-month follow-up period were performed using Cox proportional hazards models.

Occurrence of IOP ≥24 mmHg, IOP ≥30 mmHg, or an increase in IOP ≥10 mmHg from baseline within 12 months, as well as IOP-lowering medication use and glaucoma surgery.

A total of 790 eyes treated with SCS-TA were matched to 790 DEX-treated eyes and 790 control eyes. The SCS-TA group received a mean of 0.6 additional SCS-TA injections and 1.0 total CS injections, compared with 1.0 DEX injections and 1.2 total CS injections in the DEX group. Within 12 months, IOP ≥24 mmHg occurred in 25.7% of SCS-TA eyes and 24.7% of DEX eyes compared with 12.0% of controls (SCS-TA: Hazard Ratio [HR] 2.21, 95% Confidence Interval [CI] 1.73-2.82; DEX: HR 2.11, 95% CI 1.65-2.69; both P<0.001). IOP-lowering medication use increased in both CS groups during follow-up. Glaucoma surgery occurred at crude 12-month rates of 2.0% for SCS-TA, 1.1% for DEX, and 1.4% for controls, with no significant differences between groups (SCS-TA: HR 1.33, 95% CI 0.62-2.86, P=0.469; DEX: HR 0.74, 95% CI 0.31-1.78, P=0.50).

In this large real-world cohort of patients with NIU, both SCS-TA and DEX were associated with higher risks of clinically significant IOP elevation compared with systemic therapy controls, with broadly similar incidence between the two CS delivery approaches. Although IOP-lowering medications were more frequently required, the overall incidence of glaucoma surgery remained low.