Conjunctival Necrosis Due to Subconjunctival Injection of Betamethasone in Treatment of Graft Rejection After Penetrating Keratoplasty

Abstract

Abstract. A rare side effect of betamethasone applied subconjunctivally is described. A 51 -year-old man who had undergone penetrating keratoplasty in his left eye 2 months previously developed graft rejection and was treated by subconjunctival injection of betamethasone. Within 2 weeks, the patient complained of conjunctival hyperemia and irritation. Biomicroscopic examination revealed conjunctival and subconjunctival necrosis with white necrotic tissue at the subconjunctival corticosteroid injection site. Simple debridement and primary wound closure of the involved area resulted in complete healing. Ophthalmologists should be aware that subconjunctival injection of betamethasone may cause conjunctival necrosis. [Ophthalmic Surg Lasers Imaging 2005;36:348-349.]

Osseous metaplasia in the conjunctiva of a horse presenting with recurrent ulcerative keratitis

“…Although the horse presented with a 6 month history of ocular inflammation OS, the recurrent episodes of ulcerative keratitis had only become apparent 1 month after the subconjunctival MPA injection. Conjunctival irritation, ulceration and necrosis have been reported following subconjunctival injections of MPA and betamethasone in man (Zamir and Pe'er 1999; Güngor et al . 2005).…”

“…Although the horse presented with a 6 month history of ocular inflammation OS, the recurrent episodes of ulcerative keratitis had only become apparent 1 month after the subconjunctival MPA injection. Conjunctival irritation, ulceration and necrosis have been reported following subconjunctival injections of MPA and betamethasone in man (Zamir and Pe'er 1999;Güngor et al 2005). Subconjunctival MPA and triamcinalone acetate (TA) have been associated with granuloma formation in the dog (Fischer 1979;Hakanson et al 1991) and this is listed in numerous textbooks as a potential complication in the horse (Slatter 2001;Dwyer and Gilger 2005).…”

Steroid depot injection versus postoperative steroid eyedrops to prevent inflammation and macular edema after cataract surgery

“…However, depending on the case, more frequent dosing or even stopping the steroid in inadvertent endophthalmitis and secondary glaucoma may be required. This, as well as histologic toxicity 8 and conjunctival necrosis, 9 is an obvious limitation to the use of depot injections.…”

Conjunctival necrosis due to subconjunctival methylprednisolone (Depo-Medrol™) acetate injection

“…Ulcerating lesion at presentation, staining with fluorescein Zyl and Hill: Conjunctival Necrosis Due to Subconjunctival Methylprednisolone after a subconjunctival injection of betamethasone following a penetrating keratoplasty 3. …”