MAR 11, 2010
The use of subconjunctival steroid injections in the treatment of patients with scleritis has been an area of significant controversy over the last decade, with strongly held opinions published on both sides of the issue. A number of recently published uncontrolled case series have suggested the safety and efficacy of this approach, but other published series and anecdotes of disastrous consequences from this treatment have chastened the uveitis community from accepting this therapy as a standard treatment.
In this study, David S. Chu and colleagues retrospectively review the charts of 11 patients (12 eyes) with scleritis treated with sub-Tenontriamcinolone acetonide (TA) injections. Of note, the author's method of injection differed from the technique reported in the other recently reported series; rather than giving a lower volume (0.1-0.2 cc) subconjunctival injection of TA in each quadrant with diffuse or nodular scleral inflammation, the authors uniformly administered 1.0 cc of TA transconjunctivally in the inferotemporal orbit, regardless of the location of the scleral inflammation. Also of note, seven patients were treated with oral corticosteroids, with four treated only with nonsteroidal anti-inflammatories, and three were exposed to an immunosuppressive such as methotrexate or mycophenolate mofetil.
At a follow-up of about three weeks, ten of the patients reported subjective improvement, and ten showed objective improvement in ocular inflammation., Side effects occurred in three patients and were manageable and within the realm of what one would expect with local steroid injections: cataract progression, ocular hypertension (controlled with drops), and subconjunctival hemorrhage with periorbital ecchymoses.
The authors note that four previously published series indicate a total of 65 successfully treated patients out of a total of 70, equating to a 95 percent success rate for subconjunctival steroid injections in scleritis, with no observed catastrophic occurrences such as scleral thinning. The authors reasonably conclude that their report adds credence to the notion that sub-Tenon corticosteroid injections may be a useful adjunct in reduction of pain and sclera inflammation in patients with non-necrotizing scleritis.