Suprachoroidal Triamcinolone Acetonide in Noninfectious Uveitic Macular Edema: A Systematic Review of Evolving Clinical Evidence.

Abstract

Purpose: Macular edema is a leading cause of vision loss in noninfectious uveitis (NIU). Suprachoroidal triamcinolone acetonide (CLS-TA) has emerged as a targeted corticosteroid delivery strategy with a favorable anatomical and functional profile. This systematic review aimed to evaluate the efficacy and safety of CLS-TA in NIU-associated macular edema by synthesizing evidence from clinical trials and real-world studies.Methods: A comprehensive search of PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL), supplemented by manual screening of reference lists, was conducted from database inception to March 1, 2026. Fourteen studies were included, comprising randomized controlled trials, post hoc and extension analyses, and real-world observational cohorts. Due to overlapping patient populations, a descriptive synthesis was performed.Results: Across studies, CLS-TA demonstrated consistent improvements in best-corrected visual acuity (BCVA), ranging from +7 to +16 ETDRS letters, alongside significant reductions in central macular thickness (CMT) of approximately 152 to 200 µm. Clinically significant intraocular pressure (IOP) elevation (≥30 mmHg) occurred in fewer than 10% of patients in controlled trials and 11.8% in real-world cohorts, with prior glaucoma or ocular hypertension identified as a key risk factor. Cataract progression over 24 to 48 weeks of follow-up was infrequent and comparable to control groups.Emerging evidence supports the efficacy of CLS-TA in broader clinical contexts, including pediatric uveitis, mixed-etiology cystoid macular edema, and cases refractory to sub-Tenon corticosteroid therapy.Conclusions: Suprachoroidal CLS-TA represents an effective and well-tolerated treatment option for NIU-associated macular edema, with a favorable safety profile and expanding clinical applicability. Further long-term and comparative studies are warranted to define its role within the evolving therapeutic landscape.