Suprachoroidal triamcinolone acetonide for macular edema: A systematic review of efficacy and safety

To systematically review the efficacy and safety of suprachoroidal injections of triamcinolone acetonide for the treatment of macular edema across various etiologies.

A systematic literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Google Scholar for studies published between January 2010 and December 2025, in accordance with PRISMA 2020 guidelines. Randomized controlled trials, prospective and retrospective clinical studies, and meta-analyses evaluating suprachoroidal triamcinolone acetonide in adult patients with macular edema were included. Primary outcomes were changes in best-corrected visual acuity and central macular thickness. Secondary outcomes included intraocular pressure elevation, cataract progression, and serious ocular adverse events.

Twelve primary clinical studies met the inclusion criteria, including phase 3 randomized controlled trials, one integrated phase 3 analysis, one phase 2 randomized trial, and multiple prospective and retrospective observational studies, comprising a total of 571 treated eyes/patients. High-quality evidence was available for non-infectious uveitic macular edema, where suprachoroidal triamcinolone acetonide resulted in significantly greater visual and anatomical improvement compared with sham treatment, with 47.4% of patients achieving a ≥ 15-letter gain in visual acuity at 24 weeks compared to 16.7% in the control group (RR=2.84; P<0.001). In diabetic macular edema, consistent anatomical improvement was observed, although functional outcomes were heterogeneous. Evidence in retinal vein occlusion was limited but suggested potential benefit, particularly when used in combination with anti-vascular endothelial growth factor therapy. Intraocular pressure elevation occurred in a minority of patients and was generally manageable. Cataract progression and serious ocular adverse events were uncommon.

Suprachoroidal triamcinolone acetonide appears to be an effective and generally safe treatment option for macular edema, with the strongest evidence supporting its use in non-infectious uveitic macular edema. Evidence for diabetic macular edema and retinal vein occlusion remains limited, highlighting the need for further large-scale randomized controlled trials.