Intravitreal Triamcinolone Acetonide Resolves Serpiginous-like Choroiditis, Study Finds

Serpiginous-like choroiditis is a distinct, aggressive posterior uveitis often linked to Mycobacterium tuberculosis that frequently necessitates a complex, systemic regimen of anti-tubercular therapy (ATT) and high-dose steroids; however, while previous research has explored higher 4 mg doses for classic serpiginous choroiditis, a significant clinical gap remains for patients who are intolerant to systemic medications or require rapid foveal protection, leading Dr. Ankush Kawali and his team at the Department of Uveitis and Ocular Immunology, Narayana Nethralaya, to evaluate the safety and efficacy of a more targeted 2 mg IVTA approach.

Therefore, the retrospective observational study, conducted at a tertiary eye care center in South India between January 2018 and December 2024, analyzed 15 eyes from 14 patients who received the 2 mg IVTA intervention and were monitored for a minimum of six months to assess long-term outcomes. The investigators utilized electronic medical records and advanced imaging, such as fundus autofluorescence (FAF), to measure primary endpoints including the time to complete lesion resolution and the incidence of paradoxical worsening, while excluding any patients with insufficient follow-up data to ensure a clear, crisp analysis of therapeutic durability.

Key Clinical Findings of the Study Includes:

• Systemic Steroid Sparing: Impressively, 71.4% of the cohort achieved successful inflammatory control without any systemic corticosteroids, effectively reducing the risk of common oral steroid complications like hyperglycemia or hypertension.

• Rapid Clinical Healing: The study demonstrated that clinical resolution of active lesions occurred at a mean of 2.7 months, while more objective healing confirmed by FAF was achieved in an average of 5.9 months.

• Visual Enhancement: Functional outcomes were significant, with the mean best-corrected visual acuity (BCVA) improving from a baseline of 20/50 to 20/32 at the time of final resolution, supported by a statistically significant P-value of 0.006.

• Superior Safety Profile: There were no reported instances of paradoxical worsening of the choroiditis following the injection, and although 33.3% of eyes experienced an intraocular pressure (IOP) elevation above 21 mmHg, these cases were easily managed with topical medications alone.

• Reduced Recurrence Risk: When 2 mg IVTA was combined with concurrent anti-tubercular therapy, the recurrence rate dropped to a low 9%, compared to a higher rate in those managed without systemic antimicrobial coverage.

The results suggest that low-dose 2 mg IVTA is a highly promising and cost-effective primary or adjunctive treatment for SLC, facilitating rapid lesion resolution and favorable visual outcomes with a manageable side-effect profile.

Thus, the study concludes clinicians may find that this localized steroid approach offers a pragmatic way to preserve central vision while minimizing the systemic medication burden, particularly in patients with comorbidities or those who show intolerance to oral therapies.

While the study is currently limited by its retrospective design and relatively small sample size, the attractive results highlight the potential for localized steroids to transform care and underscore the need for future randomized controlled trials to establish standardized treatment protocols.

Reference

Kawali A, Anupama S, Mishra SB, Mahendradas P. Intravitreal triamcinolone acetonide therapy in serpiginous-like choroiditis. Indian J Ophthalmol 2026;74:548-53.