Comparison of Vabysmo Versus Suprachoroidal Triamcinolone Acetonide in Respect of Visual Acuity and Resolution of Macular Edema in Post-Uveitic Macular Edema

Abstract

Background: One of the most common complications of uveitis that leads to long-term vision loss is post-uveitis macular edema (PUME). However, there is variable effectiveness of conventional drugs such as steroids and anti-VEGF drugs and they often have side effects and/or recur.

Objectives:  This study was designed to determine the efficacy and safety of Wabysmo vs SCTA in patients with PUME.

Study design:  The study was a randomized, comparative interventional study and conducted for 12 months.

Material and Methods: The study was a prospective, randomized, comparative interventional study Conducted from September 2022 to August 2023 involving 60 patients with post-uveitic macular edema (PUME) that were confirmed on optical coherence tomography (OCT). Patients were randomly selected into two groups of equal number: Group A – intravitreal injection of Wabysmo (faricimab 6mg/0.05ml) and Group B – suprachoroidal injection of triamcinolone acetonide (4mg/0.1ml). Assessment of best corrected visual acuity (BCVA, logMAR), central macular thickness (CMT) and safety outcomes was performed at 1, 3, and 6 months. Paired and independent t tests, chi square tests were carried out and a p-value < 0.05 was taken as significant.

Results: After 6 months, both groups experienced a significant improvement in BCVA and decrease in CMT. However, the Wabysmo group showed greater improvement in BCVA (-0.49 ± 0.11 vs -0.39 ± 0.12 logMAR, p = 0.002) and greater reduction in CMT (-220.9 ± 38.7 µm vs -160.4 ± 41.2 µm, p < 0.001) compared to the SCTA group. The Wabysmo group had a higher rate of complete resolution of macular edema (66.7% vs 43.3%, p = 0.047). Wabysmo had more favorable safety profile with less incidence of intraocular pressure elevation and cataract progression when compared with the SCTA group.

Conclusion: Wabysmo and suprachoroidal triamcinolone acetonide have proven effective in treating PME (treating post-uveitis macular edema). Wabysmo, however, showed better visual and anatomical results and with less side effects.

Keywords: Post-uveitis macular edema, Wabysmo, Faricimab, Suprachoroidal triamcinolone acetonide, and Uveitis.