Retina Society 2026: Local steroid options for uveitic macular edema

Even with good control of the underlying uveitis through systemic immunomodulatory therapy, uveitic macular edema often requires repeated adjunctive treatment with corticosteroid injections. Kareem Moussa, MD, associate professor of clinical ophthalmology in the Department of Ophthalmology and Vision Science at the University of California, Davis, presented a retrospective comparison of intravitreal dexamethasone implant, intravitreal triamcinolone acetonide, periocular triamcinolone acetonide, and suprachoroidal triamcinolone at the 59th Annual Scientific Meeting of The Retina Society, held September 23-26, 2026, in Los Angeles, California.

In this Q&A conversation with Modern Retina, Moussa discusses how the options compared on effectiveness and intraocular pressure (IOP), which patient factors may guide the choice of injection, and what he hopes retina specialists take back to clinic.

Note: Transcript edited lightly for clarity and length.

MR: Your talk compares different local corticosteroid injection options for uveitic macular edema. Which specific agents or delivery approaches did you compare, and was there a clear efficacy leader, or did the results come down more to a trade-off between durability and safety?

Kareem Moussa, MD: We compared intravitreal dexamethasone implant, intravitreal triamcinolone acetonide, periocular triamcinolone acetonide, and suprachoroidal triamcinolone.

Our primary outcome was a clinically significant improvement in macular edema at 6 weeks after the injection, which we defined as meeting 1 or more of the following criteria:

• Reduction of central subfield thickness on optical coherence tomography (OCT) of 20% or more.
• Resolution of all fluid on OCT.
• Normalization of macular thickness.

We detected no statistically significant difference in meeting the primary outcome between these 4 corticosteroid injections. Numerically, intravitreal dexamethasone implant had a greater proportion of eyes that met the primary outcome, but this did not achieve statistical significance in our study. None of the injections were clearly superior in terms of effectiveness.

MR: Local corticosteroids for uveitic macular edema carry familiar risks—IOP elevation and cataract progression chief among them. Did your data show meaningful differences in those safety signals between the options you studied, or were the risks similar across the board?

Moussa: Yes, we did detect a safety advantage with respect to IOP for the suprachoroidal triamcinolone acetonide injection. At 24 weeks (6 months) after the injection, the mean IOP was significantly lower in the group that was treated with suprachoroidal triamcinolone acetonide than compared with the group treated with the intravitreal dexamethasone implant.

Although this is a meaningful result that supports the safety signal shown in the randomized PEACHTREE trial (NCT02595398) for suprachoroidal triamcinolone acetonide, all groups overall did well with respect to IOP, with no significant differences in the need to escalate IOP-lowering treatment between groups. Because this study was retrospective and with a limited follow-up period of 6 months, we did not assess the effect of corticosteroid injections on cataract progression, which typically requires multiple injections over a longer period.

MR: Given the differences you found, how should a retina specialist decide which corticosteroid option is right for a given patient? Are there specific patient factors, like glaucoma history or lens status, that should drive the choice?

Moussa: The good news is that all of these injections work well for uveitic macular edema. It does seem that suprachoroidal triamcinolone acetonide may result in less IOP elevation compared to intravitreal dexamethasone implant, so retina specialists may want to consider utilizing this route in eyes that have ocular hypertension, glaucoma, or at risk of developing these conditions.

MR: Uveitic macular edema often requires repeat treatment. How did the options you compared stack up in terms of durability of effect, and how does that factor into treatment burden for patients with chronic or recurrent uveitis?

Moussa: This is correct. Even with good control of the underlying uveitis with systemic immunomodulatory therapy, often uveitic macular edema requires repeated adjunctive treatment with corticosteroid injections. This study did not look at need for retreatment, as there are several variables that may influence this outcome that would be difficult to account for in a retrospective study. For patients with chronic posterior uveitis requiring multiple corticosteroid injections, retina specialists may want to consider the intravitreal fluocinolone acetonide 0.19 mg implant, which provides sustained release of corticosteroid for 2-3 years.

MR: If a retina specialist only takes one thing from your talk into clinic tomorrow, what would you want that to be?

Moussa: If you have not yet, learn how to do a suprachoroidal injection. Multiple studies suggest a safety benefit with respect to IOP in uveitic macular edema, and this route is being investigated for other retinal diseases, so it is worth learning. The other injections work well, too, and ultimately the “best” option depends on a patient’s clinical characteristics. Being comfortable with all the options will help you make the most sensible choice for each patient.

Kareem Moussa, MD, is associate professor of clinical ophthalmology with the Department of Ophthalmology and Vision Science at University of California, Davis in Sacramento, California.