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This abstract is assigned to session Free Paper Session V: Treatment
Presentation preference Oral presentation
TitleSubconjunctival Triamcinolone Injection for Infectious Necrotizing Scleritis
PurposeDemonstrate the utility of subconjunctival triamcinolone injection for infectious necrotizing scleritis.
MethodsRetrospective 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.
ResultsMean 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.
ConclusionPeriocular 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 interestYes
Details of conflicting interestsJWH is a paid consultant for Mallinckrodt. GLP and FES have no financial disclosures.
Author 1
Last namePALEY
Initials of first name(s)GL
CitySt Louis
CountryUnited States
Author 2
Last nameEl Sayyad
Initials of first name(s)F
CitySt Louis
CountryUnited States
Author 3
Last nameHuang
Initials of first name(s)JW
CitySt Louis
CountryUnited States