Risk of intraocular pressure elevation associated with triamcinolone acetonide administration via different routes in macular edema: a systematic review and network meta-analysis of randomized controlled trials

Abstract

Aims: Despite their overall favourable safety profile, the intraocular pressure increases after any routes of triamcinolone acetonide application are not rare. We designed a systematic review and network meta-analysis to compare risk of IOP elevation among TA for different routes of administration used by patients diagnosed with macular edema. Methods: We obtained data from the PubMed, MEDLINE, Embase, and Cochrane Library. We performed random-effects model and consistency model network meta-analyses to summarize the evidence. The Bayesian approach was used for direct and indirect comparisons, and the treatments were ranked by the surface under the cumulative ranking curve. The study was registered with PROSPERO, CRD42022366513 Results: Sixteen studies were included in the network meta-analysis. There was a significant difference in IOP between IVTA and STiTA (MD, 1.67 [95% CrI, 0.25, 3.15]) at the 12th week. At the 24th week, compared with the placebo group, IVTA, SCTA and STiTA had statistically significant effect on IOP (MD, 1.35 [95% CrI, 0.23, 2.30], 2.42 [95% CrI, 4.53, 0.19], and 1.31 [95% CrI, 2.49, 0.02]). The probabilities of rankings and SUCRA showed that IVTA and SCTA were generally considered the higher risk of IOP elevation than the other routes of injection therapy. In addition, RITA was shown to be safer. Conclusion: IVTA and SCTA appeared as the least safe routes of injection therapy for ME, which being more prone to increase the risk of IOP elevation. RITA demonstrated a safer profile. However, more high-quality randomized controlled trials will be necessary to further confirm this.