Subconjunctival Triamcinolone Injection for Infectious Necrotizing Scleritis
Purpose
Demonstrate the utility of subconjunctival triamcinolone injection for infectious necrotizing scleritis.
Methods
Retrospective review of three patients with culture-proven Pseudomonas keratitis who developed progressive necrotizing scleritis despite topical fortified antibiotics, topical steroids, and oral antibiotics. Ultimately, subconjunctival triamcinolone injection was performed by a cornea specialist. Outcome measures included resolution of the acute inflammatory episode, incidence of scleral perforation or steroid-induced elevated intraocular pressure (IOP), and final visual acuities.
Results
Mean patient age at time of steroid injection was 85 years (range 74-93 years). The patients were followed on average for 19 months (range 15-21 months). Two patients later underwent penetrating keratoplasty, one combined with cataract surgery, with final best-corrected visual acuities in the affected eyes of 20/300 and count fingers at 4 feet, respectively. The third patient deferred surgery and had light perception vision from dense corneal scarring in the affected eye. None of the patients developed recurrent scleritis, scleral perforation, or IOP elevation after steroid injection.
Conclusion
Periocular corticosteroid injection in necrotizing scleritis is commonly thought to increase the risk of scleral melt and perforation. In this case series, subconjunctival triamcinolone injection was safely used in three patients with necrotizing scleritis. When used judiciously, this treatment appears to mitigate scleral necrosis and may avoid potential complications associated with use of systemic steroids.
Conflict of interest
Yes
Details of conflicting interests
JWH is a paid consultant for Mallinckrodt. GLP and FES have no financial disclosures.
Author 1
Last name
PALEY
Initials of first name(s)
GL
City
St Louis
Country
United States
Author 2
Last name
El Sayyad
Initials of first name(s)
F
City
St Louis
Country
United States
Author 3
Last name
Huang
Initials of first name(s)
JW
City
St Louis
Country
United States
This website uses cookies to ensure you get the best experience on our website.
Learn more