EMBARGOED: September 27, 2018 1:00PM EST
Contact: Ilana Nikravesh
Mount Sinai Press Office
Study Identifies Most Effective Treatment Approaches for Uveitic Macular Edema
Results may lead to better management of complex eye condition
Newswise — (New York, NY – September 24, 2018) - Injections of corticosteroids directly into the eye are superior to those placed adjacent to the eye for treating uveitic macular edema, one of the leading causes of blindness in the United States, a Mount Sinai-led research study has found. The results, published in the September 27, online issue of Ophthalmology, can help to improve vision in patients with the disease.
“The results of this study suggest that we should be shifting away from periocular injections and towards intravitreal injections of corticosteroids for uveitic macular edema, which should improve the management of patients with uveitis,” said Douglas A. Jabs, MD, MBA, Director of the Eye and Vision Research Institute at the New York Eye and Ear Infirmary of Mount Sinai; Professor of Ophthalmology and Medicine at the Icahn School of Medicine at Mount Sinai; and the study chair.
Macular edema is the swelling of the macula (the area in the center of the retina responsible for good central vision) due to leakage from inflamed blood vessels; it can lead to decreased vision. It is also the leading cause of visual impairment in patients with uveitis, but can be reversed if it responds to treatment. Uveitis is a collection of more than 30 diseases characterized by inflammation inside the eye which damages the ocular tissues. It is the fifth leading cause of blindness in the United States, affecting all ages, and requires appropriate treatment to prevent vision loss. Uveitic macular edema is not always effectively treated with oral corticosteroids even when they control the inflammation, so the macular edema often requires additional therapy in the form of regional corticosteroid injections, either by a periocular (adjacent to the eye) or intravitreal (inside the eye) route.
Dr. Jabs chaired an international team of researchers as they compared and examined the effectiveness of three treatment corticosteroid approaches for patients with uveitic macular edema: regional therapy with periocular triamcinolone injections, intravitreal triamcinolone injections, and intravitreal dexamethasone implants (these slowly release mediation over a period of several months). The trial, known as PeriOcular versus INTravitreal corticosteroids for uveitic macular edema (POINT), was conducted at 23 centers across the United States, along with sites in Canada, Australia, and the United Kingdom. It followed patients for six months after the initial injection for uveitic macular edema to evaluate the injections’ comparative efficacy and safety. Patients in the trial were randomly assigned to receive either an injection of periocular triamcinolone or intravitreal triamcinolone, or the intravitreal dexamethasone implant. Researchers found both intravitreal treatments were superior to the periocular treatment for reducing macular edema and improving visual acuity. The intravitreal injection and dexamethasone implant were shown to have similar efficacy and safety profiles.
“Although all three treatments were effective in reducing macular edema and improving visual acuity, our data shows superior efficacy for intravitreal triamcinolone and intravitreal dexamethasone which suggests that the initial regional therapy of uveitic macular edema should be through the intravitreal route,” explained Dr. Jabs.
The National Eye Institute (NEI), which is part of the National Institutes of Health, funded the POINT trial.
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The Mount Sinai Health System is New York City’s largest integrated delivery system encompassing seven hospital campuses, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai’s vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The System includes approximately 6,600 primary and specialty care physicians; 10 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report’s “Best Medical Schools”, aligned with a U.S. News & World Report’s “Honor Roll” Hospital, it is ranked as a leading medical school for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report’s “Honor Roll” of top U.S. hospitals; it is one of the nation’s top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 “Best Hospitals” issue. Mount Sinai’s Kravis Children’s Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat, while Mount Sinai Beth Israel, Mount Sinai St. Luke’s and Mount Sinai West are ranked regionally. For more information, visit http://www.mountsinai.org/, or find Mount Sinai on Facebook, Twitter and YouTube.