Subtenon Triamcinolone Acetonide Injection with Topical Anesthesia in Pediatric Non-Infectious Uveitis

Abstract

Introduction: Subtenon triamcinolone acetonide (KenalogÒ; Bristol Myers Squibb) (STA) injections are commonly used in the treatment of adults in an outpatient setting. However, publications on detailing its outpatient use, safety, and efficacy in the pediatric population are scarce. Methods: We reviewed STA injections performed in children in the outpatient clinics at two tertiary centers from 2014 to 2020. All children were aged B 18 years and had a diagnosis of non-infectious uveitis. STA injections were done using 0.5 cc (20 mg) triamcinolone injected superotemporally with only topical anesthesia. Data on the efficacy and safety of STA in treating inflammation and compiled data on visual acuity improvement and inci-dence of ocular complications were evaluated. Results: Forty-eight eyes in 30 patients were included. The mean age of patients was 13.1 (range 7-18) years. There were no immediate complications observed in all injections performed. At the 3-month follow-up, inflammation had improved in 85.4% of eyes, macular edema had resolved in 77.8% of eyes, and there was significant vision improvement after STA. At 6 months after STA, the incidence of ocular hypertension was 12.5% and no new cataracts had developed. Conclusion: STA injection with topical anesthesia was a well-tolerated, reasonable alternative for short-term treatment of uveitis among this pediatric population.

Risk factors for failing sub-Tenon’s triamcinolone acetonide for uveitic macular edema

“…All injections were done as superior posterior sub-Tenon’s injections, using a modified Nozik technique described previously [ 8 ]. This method has been found to have similar efficacy as other periocular routes [ 15 , 16 ].…”

“…For example, Leder et al reported that 57% of eyes had clinical resolution of uveitic ME 3 months after a single STA [ 7 ]. A recent report by Jung et al evaluating pediatric eyes found that 78% had resolved uveitic ME 3 months after STA [ 8 ]. STA also has some advantages over intravitreal corticosteroid therapies, including substantially lower cost, decreased risk of post-injection ocular hypertension [ 5 , 9 ], no risk for post-injection infectious endophthalmitis, longer duration of action [ 5 , 10 – 14 ], and the potential to more safely be delivered via an in-office procedure in the pediatric population [ 8 ].…”

Progress in the Use of Glucocorticoids and Biological Agents in Non-Infectious Uveitis

“…The duration of action of the drug is 3 months and the main adverse effect is higher IOP. Jung et al [19] evaluated the efficacy of PTA in the treatment of NIU in a retrospective trial of non-infected uveitis patients aged ≤ 18 years. The study found that inflammation improved in 85.4% of eyes and macular edema (ME) resolved in 77.8% after 3 months postoperatively.…”

The Evolution of Triamcinolone Acetonide Therapeutic Use in Retinal Diseases: From Off-Label Intravitreal Injection to Advanced Nano-Drug Delivery Systems

“…reported that a single dose of suprachoroidal injection of triamcinolone acetonide for the treatment of macular edema secondary to uveitis is safe and efficacious [82]. In pediatric populations, subtenon TA injection with topical anesthesia was well-tolerated and shown to be a reasonable alternative for the short-term treatment of uveitis [83].…”