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Early Adoption of Triamcinolone Acetonide Suprachoroidal Injection for Uveitic Macular Edema: A Physician Survey
Peter Y Chang, MD
Chang, Peter Y.(1); Henry, Christopher R.(2); Warrow, David (3) ; Walter, Scott D.(4); Emami-Naeini, Parisa(5); Singer, Michael A.(6); Blinder, Kevin(7); Dacey, Mark(8); Chu, David(9); Raiji, Veena(10); Rifkin, Lana M.(11); Shah, Milan(12); Yassine, Mohamed(13)
1. Massachusetts Eye Research and Surgery Institution, Waltham, MA, United States.
2. Retina Consultants of Texas, Houston, TX, United States.
3. Cumberland Valley Retina Consultants, Hagerstown, MD, United States.
4. Retina Consultants, Hartford, CT, United States.
5. University of California Davis, Davis, CA, United States.
6. Medical Center Ophthalmology Associates, San Antonio, TX, United States.
7. The Retina Institute, Saint Louis, MO, United States.
8. Colorado Retina, Denver, CO, United States.
9. Metropolitan Eye Research and Surgery Institute, Palisades Park, NJ, United States.
10. Illinois Retina Associates, Chicago, IL, United States.
11. OCB, Boston, MA, United States.
12. Midwest Eye Institute, Indianapolis, IN, United States.
13. Bausch and Lomb, Bridgewater, NJ, United States.
Purpose: Triamcinolone acetonide injectable suspension (SCS-TA; Xipere) for suprachoroidal (SC) use was recently approved in the U.S. for the treatment of uveitic macular edema (UME). We evaluated perceptions of and early experience with the injection procedure among early adopters of SCS-TA along with patient outcomes. Preliminary findings are presented.
Methods: Retina/uveitis specialists who had completed ≥10 SC injections of SCS-TA were eligible to participate in virtual meetings in which they discussed a series of pre-defined questions probing their experience.
Results: There were 12 participants with a combined experience of SCS-TA use in 243 patients and at least 291 SC injections. Patients had various uveitis etiologies, chronicity and anatomical subtype, and some (~15%) had post-surgical UME. Top reasons for adopting SCS-TA were  potential lower risk of steroid-associated IOP elevation compared to intravitreal (IVT) steroids/implants (n=12);  potential for longer duration action compared to IVT steroids/implants (n=11); and  desire to use a new delivery modality (n=10). Prior to training, half of the respondents were confident in their ability to successfully inject SCS-TA into the SC space, increasing to all respondents after training. The majority (92%) of respondents reported the injection procedure was somewhat/very easy after training and most (75%) were comfortable with the procedure after completing 2-5 injections. Most respondents recalled patients gaining 2-3 lines of vision by first follow-up visit, typically 4-6 weeks post-injection, and most (86%) had reductions in central subfield thickness ranging from 100 to 150 µm. Similar improvements were reported by two respondents who evaluated a small subset of patients at 1-2 weeks post-injection. There were no unexpected/new safety findings. Overall, most (92%) survey respondents were satisfied with SCS-TA treatment and expressed interest in use of SCS-TA in post-surgical UME patients, younger patients, and in steroid responders.
Conclusions: Perceptions and experiences of early adopters with treatments involving new delivery techniques can reveal educational gaps and provide real world evidence. Findings from this survey of early adopters of SCS-TA suggest SC injection was easy to learn and resulted in patient improvements in vision and in macular edema aligned with findings in clinical registration trials.