Long-Term, Multicenter Evaluation of Subconjunctival Injection of Triamcinolone for Non-Necrotizing, Noninfectious Anterior Scleritis

Abstract

Purpose We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, non-infectious anterior scleritis. Design Retrospective, interventional, noncomparative, multi-center study. Participants Sixty-eight eyes of 53 patients from nine participating hospitals in the United States, Singapore, and Australia. Only eyes with 6 or more months of follow-up were included. Intervention Subconjunctival injection of 2 to 40 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, non-infectious anterior scleritis. Main Outcome Measures Resolution of signs and symptoms; time to recurrence of scleritis; side effect profile. Results Median follow-up was 2.3 years (range 6 months to 8.3 years). Sixty-six eyes (97.0%) experienced improvement of signs and symptoms after one injection. Twenty-four months after a single injection, 67.6% of eyes remained recurrence-free, while at 48 months, 50.2% were recurrence-free. 55.0% of patients who had adverse effects from systemic medications were off all systemic medications at last follow-up; 55.0% of patients who were on systemic medications at the time of first triamcinolone acetonide injection were off prednisone and immunosuppressants at this time; 76.2% of patients still needing systemic agents had associated systemic disease. Fourteen eyes (20.6%) had ocular hypertension not requiring intraocular pressure (IOP)-lowering therapy. Two eyes (2.9%) were treated with topical IOP-lowering agents alone while two needed surgical intervention for glaucoma. None developed scleral necrosis or melt. Conclusions This retrospective, international study carried out at nine hospitals suggests that STI can treat non-necrotizing, non-infectious anterior scleritis with side effects limited to elevated IOP in a few patients. Though no cases of scleral melt or necrosis were observed, we cannot definitively conclude that this may not occur after STI. Intraocular pressure should be closely monitored after STI. STI may be useful as adjuvant therapy or to decrease systemic medication burden.

Subconjunctival Injection of Triamcinolone for the Treatment of Upper Lid Retraction Associated With Thyroid Eye Disease

“…27 The most common adverse effect of triamcinolone injection is an increase in intraocular pressure. 22,28 Topical steroids are more likely to cause an elevation in the intraocular pressure, and a periocular injection of a long-acting corticosteroid is the most dangerous route of administration. Steroid-induced elevation of intraocular pressure is thought to occur secondary to a reduction in outflow facility of the trabecular meshwork.…”

Treatment and management of scleral disorders

“…144 Increased intraocular pressure was the most common side effect of SCI using TA. Therefore, it is recommended to obtain a baseline IOP and monitor patients for at least 6 months.…”

Prevention and treatment of cystoid macular edema after cataract surgery

“…51 Therefore, patients with CME after cataract surgery should be treated appropriately. The optimal treatment of CME after cataract surgery is explored in chapter 6, which describes the results of a systematic review.…”

“…The time to resolution of PCME was significantly shorter in patients treated with a combination of topical corticosteroids and NSAIDs. 5,51 Recently, it was shown that an increased frequency of topical corticosteroid administration, in addition to topical NSAIDs, improves the resolution of PCME. Patients using topical prednisolone every hour while awake had superior results regarding retinal thickness and visual acuity, as compared to patients using prednisolone only four times daily.…”

“…Increased IOP is a common complication of local corticosteroid administration, but prevalence may vary between various routes of administration. [48][49][50][51] Other routes of corticosteroid administration may also prevent the occurrence of CME, involving a lower incidence of IOP increase. Previous studies have investigated the use of high frequency prednisolone eye drops, oral prednisolone, intravitreal TA, and subtenon TA.…”