Posterior Subtenon Triamcinolone Injection Research Articles

Posterior sub-tenon injection of triamcinolone in non-resolving vitreoretinitis - A case report

Purpose: To evaluate the efficacy of posterior sub-tenon injection of triamcinolone in non-resolving vitreoretinits. Introduction: Vitreoretinits is the inflammation of the vitreous and retina. In a non-resolving case of vitreoretinitis steroids are the mainstay of treatment. Steroids can be administered via various routes into the eye. Posterior subtenon injection of Triamcinolone acetonide is an effective treatment option for anatomical and functional improvement in intermediate and posterior uveitis. Methods: A 46-year-old female presented to the outpatient department with decreased vision in her left eye for 3 months. On examination, she had a BCVA of 6/60 in her left eye. Fundoscopy showed vitreous haze grade 3 due to vitritis, multiple vitreoretinal tractional bands extending along both the superior and inferior arcade, macular edema, and a retinitis patch of less than half disc diameter size just above the superior arcade. The patient was positive for IgG antibodies to Cytomegalovirus and Herpes Simplex virus. The patient was started on oral prednisolone 1mg/kgbw once a day and topical prednisolone acetate 1.0%, nepafenac 0.3%, and timolol 0.5%. The patient was given posterior subtenon injection of 0.5ml of triamcinolone acetonide 40mg/ml. Results: She had 6/12 BCVA at the end of 1 month with resolving vitritis and macular edema. By the end of 3 months, she had fully resolved vitreoretinitis with 6/6 vision. Discussion: Most steroids used in ophthalmology are glucocorticoids, which have anti-inflammatory and immunosuppressive activity. Triamcinolone Acetonide is a minimally water-soluble suspension. Triamcinolone crystals slowly dissolve into the vitreous. This creates a diffusional gradient from the vitreous to the macula with minimal systemic exposure. Our study also showed significant improvement in visual acuity and reduction in macular edema with a single posterior subtenon injection of triamcinolone acetonide. Conclusion: A subtenon injection of triamcinolone acetonide appears to be an effective treatment for decreased vision associated with intermediate and posterior uveitis without any significant side effects.

Hyperviscosity Syndrome-related Retinopathy in a Patient with Waldenström Macroglobulinemia

Purpose: We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved.Conclusions: In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.

Posterior sub-Tenon triamcinolone injection in the treatment of postoperative cystoid macular edema secondary to pars plana vitrectomy.

To evaluate the efficacy and safety of posterior sub-Tenon triamcinolone (PSTA) in chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy (PPV). Consecutive 22 patients who developed chronic PCME after PPV and underwent PSTA treatment were included in this retrospective study. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured pre injection and post injection at one month, three months, six months, and at last visit. The patients were divided into three groups according to the injection response status: complete, partial, and resistant. The mean follow-up period was 26.4 ± 16.2 months after PSTA. According to pre-injection values, there was a significant improvement in the values of BCVA and CMT at the first, third, and sixth months and at the last examination (P < 0.05). In the final examination, PCME recovered completely in 12 patients, partially in 8 patients, and resistance was observed in 2 patients. Posterior sub-Tenon triamcinolone seems to be effective in chronic PCME following PPV.

Commentary: Treatment of postoperative cystoid macular edema in vitrectomized eyes: An enigma.

Post-operative cystoid macular edema (PCME) is a sight-threatening complication that could affect visual recovery following a successful ocular surgery. Irvine–Gass syndrome, that is, PCME following cataract surgery has extensively been studied. The incidence of clinical CME following phacoemulsification ranges from 0.2% to 2.35%.[1] The incidence of PCME following vitrectomy for vitreous floaters, rhegmatogenous retinal detachment (RRD), and the epiretinal membrane (ERM) has been found to be around 5%, 10–25%, and 13–47%, respectively.[1-4] Although the exact pathophysiology of PCME remains debatable, the most probable cause seems to be subclinical low-grade inflammation. Studies have shown that the levels of cytokines and prostaglandins are elevated in such eyes, leading to blood–aqueous barrier breakdown and consequent fluid accumulation.[1-4] Pole et al.[2] described the optical coherence tomography (OCT) characteristics of PCME after RRD surgery. These included fovea-involving diffuse CME, which involved all four macular quadrants and cysts in the inner nuclear and outer plexiform layers. In untreated eyes, the cysts may coalesce into larger irregular, polygonal-shaped cavities. CME may resolve spontaneously but cause disorganization and atrophy of the retinal layers. Several risk factors for the development of PCME following vitrectomy have been identified. Risk factors following RRD surgery include old age, cataract surgery, macula-off RRD, longer duration, pre-existing proliferative vitreoretinopathy changes (C or higher), intra-operative retinectomy, and multiple surgeries.[12] Risk factors following ERM removal surgery include old age, cataract surgery, stage 4 ERM, and the presence of pre-existing intraretinal cysts.[34] The post-operative tamponading agent did not influence the development of PCME in either pathology.[1-4] To date, there has been no consensus on the treatment for PCME. Its management is often complex due to its recurring nature. The various available treatment options include topical steroid and non-steroidal anti-inflammatory drug (NSAID) drops; intravitreal anti-vascular endothelial growth factor (VEGF) and triamcinolone acetonide (TA) injections; intravitreal dexamethasone and fluocinolone implants; suprachoroidal triamcinolone injection; and posterior subtenon and trans-tenon retrobulbar triamcinolone injection. The efficacy of topical treatment in previously vitrectomized eyes is usually limited.[12] Similarly, anti-VEGF injections also tend to be less effective in vitrectomized eyes due to faster clearance and reduced half-life.[12] Intravitreal triamcinolone acetonide (IVTA) injection has been found to be better than anti-VEGF injections in improving macular thickness and visual acuity.[2] However, the mean elimination half-life in vitrectomized eyes is merely 3.2 days compared to 18.6 days in non-vitrectomized eyes.[5] On the contrary, the vitreoretinal pharmacokinetic profiles of dexamethasone and fluocinolone implants in vitrectomized eyes are similar to that in non-vitrectomized eyes. Intravitreal dexamethasone implant has been found to be an effective treatment option for eyes with PCME following vitrectomy for RRD and even endophthalmitis.[67] Eyes that underwent vitrectomy for ERM compared to RRD, presence of subretinal fluid, intact outer retinal layers, and worse baseline best-corrected visual acuity (BCVA) have higher chances of visual improvement. Owing to the recurrent nature of the disease, multiple injections are often needed.[6] Intravitreal fluocinolone acetonide implant has been shown to achieve persistent functional and anatomical improvement with long recurrence-free periods. Miguel–Escuder et al.[8] suggested that it could be considered as a therapeutical option in eyes with refractory PCME following vitrectomy. Suprachoroidal TA injection with the help of custom-made needles is another treatment option. Due to its unique position, the suprachoroidal space serves as a drug reservoir with slow drug washout and better absorption. Animal model-based pharmacokinetic studies have shown that a 12-fold higher drug concentration can be achieved in the retina along with reduced entry drug in the anterior chamber, thus reducing the risk of intraocular pressure rise and cataract formation.[9] Trans-Tenon’s retrobulbar TA infusion has also been used successfully for the management of refractory diabetic macular edema (DME) in vitrectomized eyes. The described technique included making an incision in the conjunctiva and the Tenon’s capsule in the inferotemporal quadrant followed by infusion of 40 mg triamcinolone acetonide with a 25-gauge curved blunt cannula into sub-Tenon’s space under topical anesthesia.[10] Posterior subtenon triamcinolone (PST) injections have classically been used for the management of intermediate uveitis. It has been shown to provide a sustained high level of TA in the vitreous cavity level along with low systemic TA levels that cannot alter the systemic cortisol levels.[11] We congratulate the authors for their manuscript evaluating the efficacy and safety of PST for the treatment of chronic PCME in vitrectomized eyes.[12] However, prospective randomized studies with a larger sample size are required to compare the efficacy with other treatment modalities. Because simultaneous complicated cataract surgery is itself a risk factor for the development of PCME, eyes with nucleus drop should be excluded. Additionally, the management of a raised intraocular pressure in the steroid responder eyes may be challenging, because the depot of TA in the posterior subtenon location is difficult to remove completely.

Effect of Posterior Subtenon Triamcinolone Acetonide in Refractory Diabetic Macular Edema

Objectives: To see the effect of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection in refractory Diabetic Macular Edema (DME).&#x0D; Study Design: Quasi-Experimental Study.&#x0D; Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi, from Jun to Dec 2018.Methodology: Patients with Clinically Significant Macular Edema (CSME), with Central Macular Thickness (CMT) &gt;300 microns and those who did not respond to three consecutive Intra-Vitreal Bevacizumab (IVB) injections were included. Posterior Subtenon Triamcinolone Acetonide (PSTT) was administered by a single retina fellow using the same protocol. Each patient’s best-corrected visual acuity (BCVA), Intra-ocular pressure (IOP) and Central Macular Thickness (CMT) were evaluated on the day of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection and again at 1, 3 and 6 months.&#x0D; Results: Out of 52 patients (104 eyes), 16 females and 36 males were present. The mean age was 57.67±9.35 years. Out of 52 right eyes, the mean Central Macular Thickness (CMT) at the first visit was 388.83±172.04 µm, 332.81 ± 144.69 µm after one month, 292.81±147.59µm after six months of Posterior Subtenon Triamcinolone Acetonide (PSTT) Injection. Similarly, for 52 left eyes mean Central Macular Thickness (CMT) at the first visit is 375.79±160.81 µm, 364.52 ± 167.95 µm after one month and 323.37±155.74 µm after six months. Similar results were observed for IOP and BCVA.&#x0D; Conclusion: Posterior Subtenon Triamcinolone (PSTT) injections are effective in diabetic macular oedema, which does not respond to intravitreal anti-VEGF (IVB) therapy.

Comparison of intravitreal triamcinolone and posterior subtenon triamcinolone in diffuse diabetic macular edema

Aim: To assess the efficacy and complications of the intravitreal injection of Triamcinolone Acetonide (IVTA) as compared to posterior subtenon injection of triamcinolone (PST) for the treatment of diabetic macular edema. Materials and Methods: Twenty four patients with type II diabetes, having diabetic retinopathy with macular edema were recruited. One eye of each patient was assigned to 4mg IVTA and the other eye was given 40 mg PST. Before and one, three and six months after treatment we measured visual acuity as well as thickness of the macula, with optical coherence tomography (OCT), and intraocular pressure (IOP). Results: In the IVTA group, a reduction in foveal thickness of 150µ was observed (p = 0.012) at 3 months compared to baseline. A reduction of around 70 microns was observed in the PST group which was not statistically significant (p = 0.290). In the IVTA group, the mean visual acuity increased from 1.048+/-0.512 at baseline to 0.707+/-0.552 at 6 months, which was statistically significant (p = 0.001). In the PST group, the mean visual acuity improved from 0.797 +/-0.425 at baseline to 0.727 +/-0.448 after 6 months with visual improvement maintained in 9 eyes (45%) throughout the study period. IOP rise in IVTA group was not statistically significant; whereas, in the PST group it became statistically significant. However, IOP rise lost its significance at 6 months (p = 0.09) owing to treatment with anti-glaucoma medications. Conclusion: Both IVTA and PST can be used as effective treatment options for diabetic macular edema. Keywords: Diabetic macular edema, Foveal thickness, Intravitreal injection, Posterior subtenon injection, Triamcinolone acetonide, Visual acuity.

Posterior Subtenon Injection of Triamcinolone (PSTT) for Macular Edema in Various Retinal Conditions

Posterior Subtenon Injection of Triamcinolone (PSTT) for Macular Edema in Various Retinal Conditions

Inadvertent Globe Penetration with Posterior Sub-Tenon Triamcinolone Injection and Subsequent Laser Barricade

Inadvertent Globe Penetration with Posterior Sub-Tenon Triamcinolone Injection and Subsequent Laser Barricade

Diabetic macular edema: posterior subtenons versus intravitreal injection of steroids

Background: Diabetic retinopathy (DR) with diabetic macular edema (DME) is one of the most common complications of diabetes and can lead to visual loss in young individuals. Purpose: to evaluate the efficacy of posterior subtenon versus intravitreal triamcinolone injection for treatment of diffuse diabetic macular edema. Patients and methods: seventy six eyes of 64 patients having diffuse diabetic macular edema were included and divided into two groups; Intravitreal triamcinolon acetonide group (IVTA group) included 40 eyes of 30 diabetic individuals, injected with 4 mg (0.1ml) IVTA. Posterior subtenon triamcinolon acetonide group (STTA group) consists of 36 eyes of 34 diabetic persons injected with 40 mg (1ml) in the posterior subtenon space. The central subfield macular thickness (CMT) measured with optical coherence tomography (OCT) before injection, 3 and 6 months post-injection was evaluated. Visual acuity as Log MAR, intraocular pressure (IOP) and any complications associated with both techniques ware assessed. Results: the baseline log MAR VA was significantly improved in both groups at one, three, and six months post-injection .The IVTA and STTA groups had significant reduction in CMT three and six months after steroid injection. The mean IOP was 16.6±1.3 mmHg and 15.4±1.1mmHg at the end of follow up in IVTA and STTA groups respectively. Conclusion: both intavitreal and subtenons routes of steroid injection are good alternatives for the treatment of diabetic macular edema, but the intravitreal route has a more pronounced effect while the subtenons route is safer.

Optical coherence tomography findings predictive of response to treatment in diabetic macular edema.

ObjectiveTo evaluate the short-term efficacy of intravitreal bevacizumab (IVB) and posterior sub-tenon triamcinolone injections (PSTI) on the basis of spectral-domain optical coherence tomography (SD-OCT) patterns in diabetic macular edema (DME).MethodsWe retrospectively reviewed 73 eyes of 73 patients with DME. Based on the presence of serous retinal detachment (SRD), eyes were categorized into two groups, and either IVB or PSTI treatment was performed. Central macular thickness (CMT) and the degree of SRD were assessed preoperatively and 1 month postoperatively. The severity of intraretinal edema was approximated based on the distance from the external limiting membrane to the internal limiting membrane.ResultsIn eyes with SRD, reduction of SRD was greater with IVB than with PSTI. Moreover, reduction of intraretinal edema was greater with PSTI than with IVB. In eyes without SRD, PSTI achieved greater CMT reduction, compared with IVB.ConclusionsIn DME patients with SRD, IVB achieved greater reduction of SRD, compared with PSTI; however, intraretinal edema responded more favorably to PSTI, regardless of the presence of SRD. Our results suggest that the classification of DME based on OCT findings may be useful to predict responses to IVB or PSTI treatments.

Complications and safety profile of posterior sub-tenon triamcinolone injections in sclero-uveitis cases in a tertiary institute of northeast India

Complications and safety profile of posterior sub-tenon triamcinolone injections in sclero-uveitis cases in a tertiary institute of northeast India

Scleral abscess following posterior subtenon triamcinolone acetonide injection for diabetic macular edema

A 65-year-old male with uncontrolled diabetes, received posterior subtenon triamcinolone (PST) injection in the right eye for diabetic macular edema. Two days following PST, he developed scleral abscess at the injection site. The Gram stain showed Gram positive cocci in clusters. He responded favorably with systemic control of diabetes, topical concentrated cefazolin, concentrated tobramycin, and intravenous antibiotics. Possibility of infective complications should be considered when using periocular steroids, especially in diabetics. Strict control of diabetes and aggressive systemic antibiotics favor rapid healing in such cases.

Posterior Subtenon's Capsule Triamcinolone Acetonide Injection for the Treatment of Diabetic Macular Edema.

To evaluate and compare the efficacy of posterior subtenon's triamcinolone injections versus grid laser photocoagulation (GLP) combined with posterior subtenon's triamcinolone injection in eyes with diabetic macular edema (DME). In this prospective clinical study, 42 eyes with DME that showed a decrease in visual acuity (VA) were included. The first group consisted of 22 eyes that received a posterior subtenon's injection of 40 mg of triamcinolone acetonide under topical anesthesia. The second group of 20 eyes received macular GLP applied 1 month after subtenon's triamcinolone acetonide (STTA) injection. All patients were evaluated at baseline and 1 day; 1, 2, 4, 6, and 8 weeks; and 3 and 6 months after injection. In some patients, injections were repeated after 3 months. The main outcome measures were VA, central macular thickness (CMT), intraocular pressure, cataract progression, and frequency of complications. The mean baseline CMT for Group I was 456.85 ± 56.90 μm. The mean baseline CMT for Group II was 455.66 ± 57 μm. In the first group, mean CMTs for second week, 8th week, 12th week, and 6th month were 258.15, 276.50, 280.05, and 433.30 μm, respectively. In the second group, mean CMTs for second week, 8th week, 12th week, and 6th month were 261.42, 272.76, 284.71, and 291.76 μm, respectively. Before treatment, in the first group, the mean best-corrected visual acuity (BCVA) measured using a Snellen chart was 0.19, while the first week, third, and sixth month BCVA means were 0.59, 0.57, and 0.41, respectively. Before treatment, BCVA in the second group was 0.17, while the first week, third, and sixth month means were 0.61, 0.64, and 0.60, respectively. Treatment complications included cataracts in 4 eyes and glaucoma in 1 eye. There is a temporary therapeutic effect of posterior subtenon's triamcinolone injection without laser photocoagulation. GLP improves VA and reduces the risk of recurrent macular edema after posterior STTA injection.

Repeated Intravitreal Bevacizumab Injections versus Single Combined Intravitreal Bevacizumab and Posterior Subtenon Triamcinolone Injections for Treatment of Diabetic Macular Edema

Aim: To compare efficacy of combined intravitreal bevacizumab and subtenon triamcinolone versus three intravitreal injections of bevacizumab at one month interval for reducing foveal thickness. Methods: Sixty eyes of 30 diabetic patients with bilateral diabetic macular edema were randomly enrolled in two groups, group A eyes treated with three intravitreal injections of Bevacizumab of 1 month apart, and group B eyes treated with a single intravitreal injection of Bevacizumab comb ined with a subtenon triamcinolone in the same operative session. Pre and postoperative clinical data were measured and followed up over 6 months. Results: Difference between pre - treatment and post - treatment clinical data for each parameter in the same gro up was highly statistically significant. However, on comparing results of post treatment BCVA, IOP and CMT in both groups, there was no statistically significant difference. Conclusion: Combination of subtenon triamcinolone and intravitreal bevacizumab i s a safe and effective choice to treat DME. Original Research Article

Uveitis in Both Eyes Associated with Sweet's Syndrome

Purpose: To report a case of uveitis in both eyes caused by Sweet’s syndrome. Case summary: A 66-year-old male presented with decreased visual acuity in his left eye. Three years prior he was diagnosed with Sweet’s syndrome, with symptoms such as chill, fever and, maculopapular rash on the chest. At initial physical examination, he had 3 or 4+ inflammatory cells and flare in the anterior chambers of both eyes, as well as hypopyon in his left eye. Under the suspicion of uveitis caused by Sweet’s syndrome, he was rescribed an IV steroid injection and topical steroid agent. Three days later, his visual acuity improved to 0.3 in the right eye and 0.2 in the left eye. Hypopyon in the left eye disappeared and inflammatory cells decreased to 1~2+. He showed signs of recurrence in both eyes after 5 months and was treated with posterior subtenon triamcinolone injection in each eye. The patient showed no signs of recurrence for 10 months after injection. Conclusions: We report a case of uveitis caused by Sweet’s syndrome treated with a steroid agent resulting in good prognosis. To the best of our knowledge, this is first case of uveitis caused by Sweet’s syndrome reported in Korea. J Korean Ophthalmol Soc 2015;56(7):1122-1126

Short-Term Results of Dexamethasone Intravitreal Implant in Patients with Refractory Diabetic Macular Edema

Purpose: To evaluate the effectiveness of a dexamethasone intravitreal implant (Ozurdex) in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone. Methods: We reviewed 9 eyes of 9 patients with diabetic macular edema treated with dexamethasone intravitreal implant. The patients were included in the study if presenting with refractory diabetic macular edema of more than 3 months despite combined treatment of intravitreal bevacizumab injection with posterior subtenon triamcinolone injection or intravitreal triamcinolone injection. We assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography at initial visit and 1, 3 and 4 months. Results: The mean follow-up was 6.7 ± 2.2 months. The baseline mean BCVA was 0.81 ± 0.47 logarithm of the minimum angle of resolution (log MAR), which improved to 0.61 ± 0.37 log MAR (p = 0.017), 0.57 ± 0.38 log MAR (p = 0.011) and 0.62 ± 0.36 log MAR (p = 0.027) at 1 month, 3 months and 4 months, respectively. The baseline mean CMT was 558.0 ± 110.32 μm and decreased to 325 ± 64.21 μm (p = 0.008) and 300.22 ± 59.46 μm (p = 0.008) at 1 month and 3 months, respectively, then increased to 468.44 ± 150.85 μm (p = 0.058) at 4 months after injection. Conclusions: Dexamethasone intravitreal implant showed short-term efficacy in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone and produced significant improvements in BCVA and CMT until 3 months after injection. The CMT then increased, but BCVA was sustained until the fourth month. J Korean Ophthalmol Soc 2015;56(8):1201-1207

Effect of Posterior Subtenon Triamcinolone Injection during Vitrectomy for Idiopathic Epiretinal Membrane

Purpose: To evaluate the effect of posterior sub-Tenon triamcinolone acetonide injection combined with vitrectomy for idiopathic epiretinal membrane (ERM). Methods: This study included 40 eyes of 40 patients who underwent vitrectomy and membrane peeling for idiopathic ERM. Triamcinolone acetonide (40 mg) was injected into the posterior sub-Tenon space following vitrectomy in 20 eyes of the injected group. The other 20 eyes that did not receive the injection were selected as the control group to match preoperative visual acuity and central macular thickness with the injected group. Preand postoperative best-corrected visual acuity, central macular thickness, intraocular pressure, and complications were compared between the 2 groups. Results: The average visual acuity in the injected group improved from 0.56 ± 0.23 (log MAR) at baseline to 0.52 ± 0.36 at 1 month, 0.44 ± 0.39 at 3 months, and 0.38 ± 0.41 at 6 months postoperatively. Central macular thickness decreased from 456.2 ± 86.2 to 399.0 ± 60.1 at 1 month, 377.1 ± 71.5 at 3 months, and 353.1 ± 57.4 at 6 months postoperatively. In the control group, average visual acuity improved from 0.56 ± 0.23 at baseline to 0.53 ± 0.25 at 1 month, 0.41 ± 0.20 at 3 months, and 0.37 ± 0.24 at 6 months postoperatively. Central macular thickness decreased from 456.4 ± 74.8 to 394.9 ± 63.5 at 1 month, 377.2 ± 56.8 at 3 months, and 358.0 ± 57.2 at 6 months postoperatively. Significant differences in visual acuity and central macular thickness were not observed between the 2 groups before surgery and during the follow-up period. Intraocular pressure and complications were similar. Conclusions: Posterior sub-Tenon injection of triamcinolone acetonide combined with vitrectomy for idiopathic epiretinal membrane did not affect postoperative anatomical and functional outcomes. J Korean Ophthalmol Soc 2015;56(8):1236-1241

Comparison of the safety and efficacy of different methods of posterior subtenon Triamcinolone injection

Comparison of the safety and efficacy of different methods of posterior subtenon Triamcinolone injection

Posterior Subtenon Injection of Triamcinolone Acetonide after Phacoemulsification in a Patient with X-Linked Retinoschisis

To describe a case of X-linked retinoschisis with pseudophakic cystoid macular edema treated by posterior subtenon injection of triamcinolone acetonide. The patient was a 60-year-old man. His best-corrected visual acuity (BCVA) was counting fingers in the right eye. Senile cataract was found with grade II nuclear sclerosis. Optical coherence tomography revealed foveoschisis with a central foveal thickness (CFT) of 545 μm. The patient underwent uneventful phacoemulsification and in-the-bag implantation of intraocular lens. Postoperative persistent cystoid macular edema was found, with CFT increased to 787 μm. The macular edema did not respond to topical corticosteroids and nonsteroidal anti-inflammatory drugs. Triamcinolone acetonide 20 mg was injected into the posterior subtenon space 10 weeks after the surgery. Macular cystic lesions dramatically disappeared 2 months after the injection, and CFT decreased to 171 μm, with accompanying inner/outer segment disruption. His BCVA also improved to 20/100. Macular edema or foveoschisis did not recur, and BCVA remained stable 1 year after the cataract operation. Foveoschisis and pseudophakic cystoid macular edema disappeared after posterior subtenon injection of triamcinolone acetonide without recurrence during the 15-month follow-up period.

Therapeutic dilemma in serpiginous choroiditis

A 43-year-old woman had blurred vision in the left eye for 4 years. Her best-corrected visual acuity was 20/20 in the right eye and 20/200 in the left eye. The fundus showed grayish-yellow, jigsaw-puzzle-shaped lesions at the level of the retinal pigment epithelium and choriocapillaries emanating from the optic nerve head in both eyes. Fluorescein angiography showed late leakage in active lesions and hypofluorescence in hyperpigmented areas. Oral prednisolone and cyclosporine were given first. However, after posterior subtenon triamcinolone injections in both eyes and one intravitreal triamcinolone injection in the left eye, macular edema worsened. Steroid-induced central serous chorioretinopathy was suspected, so we tapered prednisolone rapidly and changed to azathioprine. Subsequent optical coherence tomography demonstrated retinal pigment epithelial detachment in the right eye subsided gradually. Fundus autofluorescence imaging showed progressively quiescent lesions. Unfortunately, acute myocardial infarction, atrial fibrillation, and ischemic stroke developed after 6 weeks azathioprine. In the acute phase of serpiginous choroiditis, corticosteroids are most commonly used. However, steroid therapy may be complicated with steroid-induced central serous chorioretinopathy. When we shift to other systemic immunosuppressive regimens, such as azathioprine, the possibility of acute myocardial infarction should be kept in mind.