Posterior Subtenon Triamcinolone Research Articles

Randomised controlled trial of posterior sub-Tenon triamcinolone as adjunct to panretinal photocoagulation for treatment of diabetic retinopathy

Aims:To evaluate the efficacy of a single posterior sub-Tenon capsule injection of triamcinolone acetonide (PSTA) before panretinal photocoagulation (PRP).Methods:This 6-month study involved the randomisation of 82 eyes of 41 patients,...

The Effect of Posterior Subtenon Triamcinolone Injection in Panretinal Photocoagulation Induced Visual Dysfunction of Diabetic Retinopathy

Purpose: To evaluate the efficacy of a prophylactic posterior sub-Tenon's capsule injection of Triamcinolone acetonide (TA) against macular edema and visual dysfunction by panretinal photocoagulation (PRP) in patients with severe nonproliferative and proliferative diabetic retinopathy. Methods: Thirty-eight eyes of 19 patients who have diabetic retinopathy without macular edema and whose retinopathy was bilateral and symmetrical were evaluated. Triamcinolone was injected into the posterior sub-Tenon's capsule in one eye of the patients and nothing was injected in the other eye as a control. Two weeks later, PRP was performed every other week for 4 sessions on both eyes in all patients. The clinical course of visual acuity and macular edema was monitored for up to approximately 6 months after the initial PRP. Results: There was no statistically significant difference of visual acuity before PRP in the 2 groups (p＞0.05), and there was no macular edema in any patient. For a follow-up period of 6 months, visual dysfunction was more severe in the TA-injected eye than the control. However, the difference was not statistically significant (p＞0.05) throughout the follow-up period except at the 20-week time point. On the other hand, macular edema occurred in 2 eyes (10.5%) of the TA-injected group, and in 4 eyes (21.1%) of the control group. IOP elevation as a complication caused by TA-injection occurred in 2 eyes (10.5%). However, IOP was controlled successfully by anti-glaucomatic eye drops. Conclusions: Posterior sub-Tenon's capsule injection of Triamcinolone is a safe and effective treatment modality for preventing PRP-induced visual dysfunction and macular edema.

Photodynamic therapy combined with posterior subtenon triamcinolone acetonide injection in the treatment of choroidal neovascularization

To evaluate the therapeutic effect of photodynamic therapy (PDT) combined with posterior subtenon injection of triamcinolone acetonide (PSTA) in the treatment of choroidal neovascularization (CNV). In this retrospective case-control study, treatment outcomes at 12 months of patients with CNV were reviewed. One hundred and two consecutive patients (102 eyes) with subfoveal CNV of various causes were included. Patients in the study group (n=46) received PDT followed within 2 days by 40 mg of PSTA. Patients in the control group (n=56) received PDT alone. Patients were retreated 3 months later or more if fluorescein angiography showed residual membrane leakage. Treatment outcomes were compared between the two groups and among different CNV subgroups. Gain in mean best-corrected visual acuity (BCVA) was significantly higher in the study group (+0.78 lines) than in the control group (-1.86 lines) (P<0.0001). The number of treatments within 1 year was significantly less in the study group (1.26 vs 1.63, P=0.008). The mean BCVA change for myopic CNV and age-related predominantly classic CNV subgroups was significantly higher in the study group (+2.82 vs -0.91 lines, P=0.0005 for myopic CNV; +0.6 vs -1.79 lines, P=0.01 for age-related predominantly classic CNV). The main side effect in the study group was increased intraocular pressure (8.7%). Compared with PDT alone, PDT combined with PSTA has a better therapeutic effect for both myopic and age-related predominantly classic CNV; the myopic CNV subgroup shows the best response.

Intraocular pressure elevation after intravitreal or posterior sub-Tenon triamcinolone acetonide injection

Background: Despite the benefits of intraocular steroids for the treatment of inflammatory, neovascular, proliferative, and edematous diseases, one of the side effects is raised intraocular pressure (IOP). In this study, we attempted to identify when IOP elevates, peaks, and returns to the preinjection baseline IOP after intravitreal or posterior sub-Tenon administration of triamcinolone acetonide, as well as the factors that might affect IOP Methods: Retrospective case review was undertaken of 69 patients (82 eyes), who received either a 4 mg intravitreal (16 eyes) or a 20 mg posterior sub-Tenon (66 eyes) triamcinolone acetonide injection. IOP assessment for each eye was completed at the preinjection baseline and at the first, third, and sixth month of follow-up. Results: The mean IOP of all eyes increased significantly at each follow-up.The mean maximum elevation ratio from the baseline was 4.0 (SD 5.2) mm Hg. An elevation of 5 mm Hg or greater occurred in 28 eyes (34.1%).The maximum elevation correlated significantly with age ( p < 0.01).The incidence of an elevation of 5 mm Hg or greater was significantly higher among patients younger than 60 years ( p < 0.01) and relatively higher among female patients ( p = 0.051). The mean IOP increased significantly at the first month after intravitreal injection but at all follow-up periods after posterior sub-Tenon injection. There was no significant difference in IOP elevation according to disease type, although eyes with diabetic retinopathy tended to be at higher risk of IOP elevation. Two eyes of two female patients, who had received posterior sub-Tenon injections for the treatment of diabetic retinopathy, required glaucoma surgery. Interpretation: The IOP elevation of 5 mm Hg or greater observed in 34.1% of the eyes was consistent with past reports. IOP elevation was associated with patients of less than 60 years of age and with female sex, and it lasted longer after posterior sub-Tenon injection than after intravitreal injection. Careful assessment of IOP during a follow-up period of at least 6 months is paramount, especially in younger female patients after posterior sub-Tenon injection.

Intravitreal Versus Subtenon Injections of Triamcinolone Acetonide for Diabetic Macular Edema

Purpose: To retrospectively evaluate the clinical effect of intravitreal (IVT) and posterior subtenon (PSTT) triamcinolone acetonide (TA) injection in diabetic macular edema. Methods: Fifty eyes of 43 patients with diabetic macular edema (DME) were included. Twenty-two eyes in the IVT group received 4 mg/0.1 ml intravitreal TA injections and 26 eyes in the PSTT group received 40 mg/1.0 ml subtenon TA injections. LogMAR visual acuity and intraocular pressure (IOP) were measured and, using OCT, central macular thickness (CMT) and total macular volume (TMV) were also measured before and 1, 3, and 6 months postoperatively. Results: Both groups showed significant decreases in the mean CMT and TMV. The mean CMT in the IVT group was significantly thinner than that of the PSTT group 1 month postoperatively. The percentage reduction in CMT and TMV were also greater in the IVT group than the PSTT group 1 month postoperatively. Both groups showed significant improvements in mean visual acuity, with no significant difference between the two groups. However, at 1-month postoperative improvement in visual acuity was significantly greater in the IVT group than the PSTT group. The mean IOP in the IVT group was also greater than that in the PSTT 1 month postoperatively. Conclusions: Both injections caused a significant increase in visual acuity and a decrease in CMT and TMV. The effect was more pronounced in the IVT group. However, the PSTT injection also appeared to be a safe and effective technique for the treatment of DME.

The Combined Effect of Subtenon Triamcinolone Injection and Panretinal Photocoagulation on Diabetic Retinopathy

Purpose: To investigate the result of posterior sub-tenon triamcinolone acetonide injection combined with panretinal photocoagulation (PRP) in patients with diabetic retinopathy. Methods: A prospective study was performed on patients with diabetic retinopathy who required PRP. The study group consisted of 12 patients (12 eyes) of diabetic retinopathy without clinically significant macular edema (CSME) and 13 patients (13 eyes) with CSME. All patients were injected posteriorly with sub-tenon triamcinolone acetonide (40 mg) one week before PRP. During a six-month follow-up, best-corrected visual acuity, the development of macular edema, changes in fluorescein angiography, and related complications were monitored. Results: During a six-month follow-up, visual acuity was well preserved in patients with diabetic retinopathy without CSME (12 eyes). Only one patient in this group experienced temporary macular edema at 3 months after combined therapy. In the CSME group (13 eyes), the visual acuities of seven patients (53.8%) increased, those of five patients (38.5%) remained same, and one patient's visual acuity (7.7%) decreased in a study period of six months. Fluorescein angiography showed that macular edema was resolved in most patients except in one patient in whom macular edema remained for up to 6 months. Complications from combined therapy occurred in two patients who showed slight and temporary increase of intraocular pressure. Conclusions: Combined treatment with posterior sub-tenon triamcinolone acetonide injection and PRP may provide benefits for patients with diabetic retinopathy who require urgent PRP by preventing exacerbation of macular edema.

Acute orbital abscess complicating deep posterior subtenon triamcinolone injection

A 54-year-old diabetic female presented with orbital abscess and corneal infiltrate 3 days after deep posterior subtenon triamcinolone acetonide injection in her right eye. This was administered immediately after focal laser photocoagulation for diabetic macular edema. The orbital abscess and corneal infiltrate responded to systemic and topical antibiotics.

Comparison of Combination Posterior Sub-Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema

PurposeTo compare the efficacy of posterior sub-Tenon's capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME).Materials and MethodsForty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured.ResultsThe ETDRS scores at baseline were 25.2 ± 13.6 (mean ± SD) letters in the PSTI + MP group, whereas 21.7 ± 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 ± 15.9, 34.7 ± 16.6 and 30.9 ± 19.0 letters in the PSTI + MP group whereas by 30.9 ± 15.4, 30.1 ± 17.9 and 31.5 ± 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p < 0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 ± 148.3, 309.1 ± 131.3, 319.3 ± 93.3, 340.4 ± 123.5 µm (mean ± SD) in the PSTI + MP group vs. 369.1 ± 123.1, 241.4 ± 52.3, 277.5 ± 137.4, 290.2 ± 127.9 µm in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the PSTI + MP group, and at both 1 month (p < 0.001) and 3 months (p = 0.016) for the IVTA group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). In contrast to the PSTI + MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group.ConclusionPSTI + MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.

Posterior Subtenon Triamcinolone, Intravitreal Triamcinolone and Grid Laser Photocoagulation for the Treatment of Macular Edema in Branch Retinal Vein Occlusion

Purpose: To evaluate the efficacy of posterior subtenon triamcinolone (PSTT), intravitreal triamcinolone (IVT) injections and grid laser photocoagulation (GLP) in eyes with macular edema secondary to branch retinal vein occlusion (BRVO). Material and Methods: Patients with macular edema due to BRVO treated with PSTT, IVT injections or GLP were evaluated retrospectively. Complete ophthalmic examination with fluorescein angiography and optic coherence tomography were noted before and in the 1st, 3rd, and 6th months of the treatment. The visual and anatomical responses were evaluated and compared between the groups using paired t test and one-way ANOVA test. Results: There were 20, 35 and 24 eyes in the PSTT, IVT and GLP groups. In the PSTT group, the mean visual acuity (VA) and central foveal thickness (CFT) were 0.23 ± 0.23 and 413.2 ± 143.5 µm before treatment and 0.23 ± 0.18 and 358.7 ± 109.2 µm at the 3rd month, respectively (p = 0.504 and p = 0.031). The mean VA increased from 0.14 ± 0.15 to 0.33 ± 0.26 and the mean CFT decreased from 518.2 ± 145 to 292.9 ± 121 µm in IVT group at the 3rd month (p = 0.001). The mean VA increased from 0.29 ± 0.25 to 0.47 ± 0.32 (p = 0.001); CFT decreased from 397.3 ± 105.9 to 307.1 ± 88.4 µm (p = 0.005) in the GLP group. VA and CFT changes were significantly different between the groups at the 3rd month (p = 0.031). VA increase was significantly greater in the IVT group than in the PSTT group. Decrease in CFT was the highest in the IVT group (Tukey, p = 0.001). Conclusions: IVT and GLP seemed to be more effective than PSTT for the treatment of BRVO-associated macular edema. Possible complications of IVT and GLP must be weighted with the advantages of each treatment modality for each patient.

Intravitreal and posterior subtenon triamcinolone acetonide in idiopathic bilateral uveitic macular oedema

To study the efficacy of intravitreal triamcinolone acetonide (IVTA) versus posterior subtenon triamcinolone acetonide (PSTA) in bilateral macular oedema secondary to idiopathic intermediate uveitis. In a prospective, interventional case series, 10 patients (20 eyes) with bilateral uveitic macular oedema were included. Patients underwent fundus fluorescein angiography, record of visual acuity and intraocular pressure (IOP). Patients received IVTA 4 mg/0.1 mL in one eye and PSTA 20 mg/0.5 mL in the fellow eye at an interval of > or =4 weeks. The outcome measures were record of IOP, best corrected visual acuity and angiographic resolution of cystoid macular oedema at 3 and 6 months. The mean pre-intervention IOP at baseline between the IVTA and the PSTA group was comparable. At 1 week, the mean IOP recorded was greater in the eyes that received IVTA than those that received PSTA (P < 0.001). However, at 1- and 3-month follow up, the mean IOP between the two groups was similar. Best corrected visual acuity of > or =6/12 achieved at 3 and 6 months in the IVTA and PSTA group was comparable (77.8% vs. 44.4% [P = 0.14] and 88.9% vs. 77.8% [P = 0.53]). There was also no significant difference in angiographic resolution of cystoid macular oedema at 3 (P = 0.32) and 6 months (P = 0.53) between the two groups. Recurrence of macular oedema was seen in one and two eyes that received IVTA and PSTA, respectively, at 6 months. Triamcinolone acetonide injection, whether administered intravitreally or via posterior subtenon route, is an effective treatment option in achieving complete anatomic and functional improvement in cases treated for macular oedema secondary to idiopathic intermediate uveitis.

Steroid-induced ptosis: case studies and histopathologic analysis

The purpose of this study was to review patients who developed ptosis after subtenon's steroid injection and to study the mechanism of steroid-induced ptosis in an animal model. Part 1. Twenty-two patients with uveitis who had received posterior subtenon's triamcinolone acetonide injections were retrospectively reviewed. Demographics, type of uveitis, type and number of surgeries, pre and postoperative marginal reflex distance (MRD1), and clinical outcomes were evaluated. Part 2. Study of rabbit levator muscle and aponeurosis histopathology after subtenon's triamcinolone injection was performed. Part 1. The average age was 44.6 years (range: 14-85 years) with a mean follow-up of 14 months. The most common causes of uveitis included uveitis after cataract extraction (five), pars planitis (three), multifocal choroiditis (three), and juvenile rheumatoid arthritis (three). The average time to documented onset of ptosis was 13.9 months (range: 0-49 months). In patients who received only one steroid injection, the average time to ptosis recorded was 2.7 months (range: 0-6 months). Seventeen patients underwent ptosis repair. Part 2. No ptosis was noted in the experimental and control groups. Histopathologic analysis of levator tissues revealed no significant difference in atrophy or degree of inflammation between experimental and control groups. Ptosis following subtenon's steroid injection ranged from mild to moderate and occurred a few months after steroid injection. Prior studies of muscles and periocular tissues exposed to corticosteroids demonstrated degenerative muscle changes; our studies revealed no histopathologic changes in the levator muscle or aponeurosis.

Intravitreal Bevacizumab for Idiopathic Choroidal Neovascularization After Previous Injection With Posterior Subtenon Triamcinolone

To assess short-term efficacy and safety of intravitreal bevacizumab injections for idiopathic choroidal neovascularization (CNV) refractory to posterior subtenon triamcinolone injections. Noncomparative, interventional case series. Intravitreal bevacizumab was injected into 10 eyes with idiopathic CNV in which posterior subtenon triamcinolone injections were not efficacious for more than three months. The main outcome measures were changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and fluorescein angiography findings before and after bevacizumab injection. After treatment, the BCVA improvement at one month (P = .029) continued to three months (P = .003). CRT decreased significantly (P < .001). Leakage from idiopathic CNV three months after treatment stopped in seven eyes, decreased in two, and continued in one. In one patient, conjunctival swelling developed after the injection but resolved and did not recur after another injection. No other complications developed. Intravitreal bevacizumab improves BCVA in eyes with idiopathic CNV refractory to triamcinolone.

Posterior subtenon and intravitreal triamcinolone acetonide for diabetic macular edema

Aim To evaluate retroprospectively the clinical consequences of posterior subtenon (PSTT) and intravitreal (IVT) triamcinolone acetonide injections in diabetic macular edema (DME) refractory to conventional grid laser photocoagulation. Material and Methods Eyes with clinically significant DME refractory to grid laser photocoagulation were assessed for the inclusion in the study. Complete ophthalmic examination with fluorescein angiography (FA) and optic coherence tomography (OCT) were performed before and in the 1st, 3rd, and 6th months of the treatment. The IVT group received 4 mg/0.1 ml and the PSTT group received 20 mg/0.5 ml triamcinolone injection. PSTT but not IVT injection was repeated in case of recurrent edema. IVT was also applied to the eyes with resistant macular edema after PSTT injection (secondary IVT group). Results There were 85 eyes of 60 patients in the PSTT group and 41 eyes of 35 patients in IVT group. There were 24 eyes in the primary IVT group and 17 eyes in the secondary IVT group. Mean follow-up time was 4.1±1.9 and 4.6±2.2 months after PSTT and IVT injections, respectively. In the PSTT group, the mean visual acuity increased from 0.19±0.18 to 0.22±0.19 and the mean central foveal thickness decreased from 413.1±117.5 to 312.1±103.1 μm ( P=.001 and P=.0001, respectively) during the first 3 months. In the IVT group, the mean visual acuity and central foveal thickness were found to be 0.15±0.14 and 494.5±141.3 μm before the treatment and 0.20±0.16 and 288.4±88.5 μm 3 months after the treatment, respectively ( P=.008 and P=.001, respectively). The effect in central foveal thickness was significantly greater in the primary IVT group than in the PSTT group ( P=.002). There was no significant difference with respect to the decrease in the central foveal thickness and increase in visual acuity between the primary and secondary IVT injections (Mann–Whitney U test, P>.05). The steroid effect started to diminish after the 3rd month. The recurrence of macular edema was seen in 7.1% in the PSTT group starting after 3 months. Twenty percent of the eyes in the PSTT group did not respond to the treatment at all and had secondary IVT injections. Significant intraocular pressure increase was found in 8.2% of the PSTT group and in 24.3% of IVT injection. There was one case of pseudomonas endophthalmitis in the IVT group. Conclusion This study is the first study comparing the clinical outcomes of PSTT and IVT injections for the treatment of DME. Both PSTT and IVT injections caused a significant increase in visual acuity and a decrease in central foveal thickness, especially in the short term. The effect was more pronounced in the IVT group; however, PSTT injection also seemed to be a safe and effective technique for the treatment of DME. Further prospective studies are warranted to assess the efficacy and side effects of IVT and PSTT injections for the treatment of DME.

Posterior Sub-Tenon Triamcinolone for Refractory Diabetic Macular Edema: A Randomized Clinical Trial

To evaluate the effect of posterior sub-tenon triamcinolone acetonide (TA) injection on clinical, angiographic, and optical coherence tomographic (OCT) parameters in refractory diabetic macular edema (DME). In a double-masked placebo-controlled clinical trial, 64 eyes were randomly assigned to two groups. The treatment group (32 eyes) received 40 mg posterior sub-tenon injection of TA and the placebo group (32 eyes) received subconjunctival injection of a placebo. The injections were repeated after 2 months in both groups. Complete ophthalmologic examination, fluorescein angiography, and OCT were performed before intervention and after 4 months. Quantitative measurement of angiographic variables such as the amount of hard exudates (HE), size of foveal avascular zone (FAZ), and leakage severity was performed by computer, using Photoshop software. Initial best-corrected visual acuity (VA) was 0.93+/-0.39 logMAR in the placebo group and 0.75+/-0.38 logMAR in the treatment group. At 4 months, corrected VA was 0.88+/-0.48 logMAR in the controls versus 0.71+/-0.42 logMAR in the cases. Mean central macular thickness measured by OCT before and 4 months after injection was 392 and 377 microns in the treatment group and 388 and 357 microns in the placebo group, respectively. No statistically significant difference was detected between the two groups. The difference was also not significant in HE, FAZ, and leakage in the angiograms. Two injections of posterior sub-tenon TA had no therapeutic effect on refractory DME.

Ptosis and Orbital Fat Prolapse after Posterior Sub–Tenon’s Capsule Triamcinolone Injection

To describe the occurrence of orbital fat prolapse and blepharoptosis after posterior sub-Tenon (PST) triamcinolone injection. Retrospective review of consecutive case series. Patients with ptosis and orbital fat herniation after PST triamcinolone injection. Charts of all patients with ptosis and orbital fat herniation presenting after PST triamcinolone injection to the oculoplastics service of the Cole Eye Institute between 1999 and 2003 were reviewed. Charts were reviewed for patient age, indication, dates of injections, time to patient complaint or time to referral for ptosis, and marginal reflex distance (MRD1). Ptosis and orbital fat herniation after PST triamcinolone injection. Eleven patients with a history of ipsilateral PST triamcinolone injections were seen with ptosis and orbital fat prolapse. Ten charts were available for review. Mean patient age was 64 years (range, 45-78 years). Patients underwent 1 to 9 ipsilateral injections, and 2 patients underwent bilateral injections. Patients were seen for ptosis evaluation on average 22.5 months (range, 3-56 months) after the initial injection, and 6.6 months (range, 0-20 months) after the most recent injection. All patients demonstrated significant orbital fat prolapse in conjunction with statistically significant ptosis (P = 0.016). Tissue was obtained in 3 cases. Histologic findings in 1 case showed orbital fat infiltrated by histiocytes that seemed to contain phagocytosed material. Posterior sub-Tenon triamcinolone injection may cause ptosis associated with orbital fat prolapse. This finding may be a relatively common complication of PST triamcinolone injection. We recommend counseling patients about this risk before PST triamcinolone injection.

Posterior subtenon triamcinolone acetonide for refractory diabetic macular edema

To evaluate posterior subtenon injection of triamcinolone acetonide for refractory diabetic macular edema (DME). Retrospective, interventional, case series. Clinical practice. Patients with persistent clinically significant DME involving the center of the fovea 3 or more months after one or more treatments of focal macular photocoagulation were included. Exclusion criteria were a history of corticosteroid-responsive intraocular pressure (IOP) rise, intraocular surgery within 3 months, and any laser treatment within 1 month. All patients received an ophthalmic history and examination including best-corrected Snellen visual acuity, IOP measurement, anterior segment examination including evaluation of lens status with LOCS II criteria, dilated fundus examination, and a posterior subtenon injection of 40 mg triamcinolone acetonide at baseline. Patients were reevaluated at 1, 3, 6, and 12 months after injection. Seventy-three injections were performed in 63 eyes of 50 patients. The mean baseline visual acuity was 20/80. Mean visual acuity significantly improved to 20/50 at 1 month, then stabilized to 20/65 at 3 months, 20/68 at 6 months, and 20/63 at 12 months. Complications were rare, with a transient significant rise in intraocular pressure at the 3-month evaluation and ptosis in two patients. Visual acuities remained stable or improved over a 12-month period after posterior subtenon triamcinolone injections for refractory DME. There was a statistically significant improvement in visual acuity at 1 month.

A Prospective Controlled Trial to Evaluate the Adjunctive Role of Posterior Subtenon Triamcinolone in the Treatment of Diffuse Diabetic Macular Edema

The aim of the present prospective controlled trial was to evaluate the adjuvant role of posterior subtenon triamcinolone in the treatment of diffuse diabetic macular edema (DDME). Thirty one (31) eyes with DDME were divided into an interventional group subjected to grid laser photocoagulation and 0.5 mL of 40 mg/mL posterior subtenon triamcinolone, and a noninterventional group subjected to grid laser photocoagulation only. Best-corrected visual acuity, contrast sensitivity, and intraocular pressures were assessed at presentation, and at 6, 12, and 24 weeks after intervention. The interventional group showed a statistically significant (p < 0.05) change in both mean best corrected visual acuity, from 20/160 to 20/100 (two-line increase on Early Treatment Diabetic Retinopathy Study (ETDRS)) (p = 0.024), and mean contrast sensitivity, from 0.9 to 1.09 (p = 0.01), at the end of 24 weeks. A significant rise in intraocular pressure was not described in any of the patients in either group. Posterior subtenon triamcinolone injection is a useful and safe adjunct to the conventional management of diabetic macular edema.

Cutaneous hypopigmentation following a posterior sub-tenon triamcinolone injection

Purpose To report a case of cutaneous skin hypopigmentation following a posterior sub-Tenon triamcinolone acetonide injection for uveitis. Design Observational case report. Methods A 28-year-old African American female with Adamantiades-Behcet disease and panuveitis was administered a posterior sub-Tenon injection of triamcinolone acetonide and developed cutaneous hypopigmentation. Results The patient developed skin hypopigmentation of the upper eyelid adjacent to the site of the sub-Tenon injection. Conclusion Injection of corticosteroids into the sub-Tenon space can cause hypopigmentation of the adjacent tissues, especially in heavily pigmented individuals.

Retinal and choroidal vascular occlusion after posterior sub-tenon triamcinolone injection

PURPOSE: To report a case of retinal and choroidal vascular occlusion occurring as a complication after posterior sub-Tenon triamcinolone injection for treatment of uveitic cystoid macular edema.DESIGN: Interventional case report.METHODS: Retrospective study. A 32-year-old woman with uveitis and cystoid macular edema underwent a right posterior sub-Tenon injection of triamcinolone (40 mg/ml, 1 ml total) through a superotemporal approach after topical anesthesia. After the procedure, the patient experienced severe eye pain, orbital ecchymosis, and globe proptosis consistent with retrobulbar hemorrhage.RESULTS: Dilated fundus examination of the right eye (OD) demonstrated multiple intraretinal hemorrhages with particulate white emboli occluding the retinal and choroidal vessels. Visual acuity was no light perception. Ocular massage and hypotensive therapy was initiated for an intraocular pressure of 50 mm Hg. Canthotomy and cantholysis were performed. A total of 39 months post-incident, her visual acuity improved to 20/100.CONCLUSION: Posterior sub-Tenon triamcinolone injection can rarely result in retinal and choroidal occlusion. Immediate intervention may preserve limited visual acuity.