Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis

Elliott H. Sohn, Robert Wang, Russell Read, Athena Roufas, Livia Teo, Ramana Moorthy, Thomas A Albini, Daniel V. Vasconcelos-Santos, Laurie D. Dustin, Ehud Zamir, Soon Phaik Chee, Peter McCluskey, Ronald Smith, Narsing Rao

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Abstract

Purpose: We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, noninfectious anterior scleritis. Design: Retrospective, interventional, noncomparative, multicenter study. Participants: Sixty-eight eyes of 53 patients from 9 participating hospitals in the United States, Singapore, and Australia. Only eyes with 6 or more months of follow-up were included. Intervention: Subconjunctival injection of 2 to 8 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, noninfectious anterior scleritis. Main Outcome Measures: Resolution of signs and symptoms, time to recurrence of scleritis, and side effect profile. Results: Median follow-up was 2.3 years (range, 6 months to 8.3 years). Sixty-six eyes (97.0%) experienced improvement of signs and symptoms after 1 injection. Twenty-four months after a single injection, 67.6% of eyes remained recurrence-free, whereas at 48 months, 50.2% were recurrence-free. Some 55.0% of patients who had adverse effects from systemic medications were off all systemic medications at last follow-up; 55.0% of patients who were taking systemic medications at the time of first triamcinolone acetonide injection were not taking prednisone and immunosuppressants at this time; 76.2% of patients still requiring systemic agents had associated systemic disease. Fourteen eyes (20.6%) had ocular hypertension not requiring intraocular pressure (IOP)-lowering therapy. Two eyes (2.9%) were treated with topical IOP-lowering agents alone, and 2 eyes required surgical intervention for glaucoma. None developed scleral necrosis or melt. Conclusions: This retrospective, international study carried out at 9 hospitals suggests that STI can treat non-necrotizing, noninfectious anterior scleritis with side effects limited to elevated IOP in a few patients. Although no cases of scleral melt or necrosis were observed, we cannot definitively conclude that this may not occur after STI. Intraocular pressure should be closely monitored after STI. Subconjunctival triamcinolone acetonide injection may be useful as adjuvant therapy or to decrease systemic medication burden. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Original languageEnglish
Pages (from-to)1932-1937
Number of pages6
JournalOphthalmology
Volume118
Issue number10
DOIs
StatePublished - Oct 1 2011

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Scleritis
Triamcinolone
Triamcinolone Acetonide
Injections
Intraocular Pressure
Disclosure
Recurrence
Signs and Symptoms
Necrosis
Ocular Hypertension
Singapore
Immunosuppressive Agents
Prednisone
Glaucoma
Multicenter Studies
Retrospective Studies
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis. / Sohn, Elliott H.; Wang, Robert; Read, Russell; Roufas, Athena; Teo, Livia; Moorthy, Ramana; Albini, Thomas A; Vasconcelos-Santos, Daniel V.; Dustin, Laurie D.; Zamir, Ehud; Chee, Soon Phaik; McCluskey, Peter; Smith, Ronald; Rao, Narsing.

In: Ophthalmology, Vol. 118, No. 10, 01.10.2011, p. 1932-1937.

Research output: Contribution to journalArticle

Sohn, EH, Wang, R, Read, R, Roufas, A, Teo, L, Moorthy, R, Albini, TA, Vasconcelos-Santos, DV, Dustin, LD, Zamir, E, Chee, SP, McCluskey, P, Smith, R & Rao, N 2011, 'Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis', Ophthalmology, vol. 118, no. 10, pp. 1932-1937. https://doi.org/10.1016/j.ophtha.2011.02.043
Sohn, Elliott H. ; Wang, Robert ; Read, Russell ; Roufas, Athena ; Teo, Livia ; Moorthy, Ramana ; Albini, Thomas A ; Vasconcelos-Santos, Daniel V. ; Dustin, Laurie D. ; Zamir, Ehud ; Chee, Soon Phaik ; McCluskey, Peter ; Smith, Ronald ; Rao, Narsing. / Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis. In: Ophthalmology. 2011 ; Vol. 118, No. 10. pp. 1932-1937.
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AU - Teo, Livia

AU - Moorthy, Ramana

AU - Albini, Thomas A

AU - Vasconcelos-Santos, Daniel V.

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N2 - Purpose: We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, noninfectious anterior scleritis. Design: Retrospective, interventional, noncomparative, multicenter study. Participants: Sixty-eight eyes of 53 patients from 9 participating hospitals in the United States, Singapore, and Australia. Only eyes with 6 or more months of follow-up were included. Intervention: Subconjunctival injection of 2 to 8 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, noninfectious anterior scleritis. Main Outcome Measures: Resolution of signs and symptoms, time to recurrence of scleritis, and side effect profile. Results: Median follow-up was 2.3 years (range, 6 months to 8.3 years). Sixty-six eyes (97.0%) experienced improvement of signs and symptoms after 1 injection. Twenty-four months after a single injection, 67.6% of eyes remained recurrence-free, whereas at 48 months, 50.2% were recurrence-free. Some 55.0% of patients who had adverse effects from systemic medications were off all systemic medications at last follow-up; 55.0% of patients who were taking systemic medications at the time of first triamcinolone acetonide injection were not taking prednisone and immunosuppressants at this time; 76.2% of patients still requiring systemic agents had associated systemic disease. Fourteen eyes (20.6%) had ocular hypertension not requiring intraocular pressure (IOP)-lowering therapy. Two eyes (2.9%) were treated with topical IOP-lowering agents alone, and 2 eyes required surgical intervention for glaucoma. None developed scleral necrosis or melt. Conclusions: This retrospective, international study carried out at 9 hospitals suggests that STI can treat non-necrotizing, noninfectious anterior scleritis with side effects limited to elevated IOP in a few patients. Although no cases of scleral melt or necrosis were observed, we cannot definitively conclude that this may not occur after STI. Intraocular pressure should be closely monitored after STI. Subconjunctival triamcinolone acetonide injection may be useful as adjuvant therapy or to decrease systemic medication burden. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

AB - Purpose: We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, noninfectious anterior scleritis. Design: Retrospective, interventional, noncomparative, multicenter study. Participants: Sixty-eight eyes of 53 patients from 9 participating hospitals in the United States, Singapore, and Australia. Only eyes with 6 or more months of follow-up were included. Intervention: Subconjunctival injection of 2 to 8 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, noninfectious anterior scleritis. Main Outcome Measures: Resolution of signs and symptoms, time to recurrence of scleritis, and side effect profile. Results: Median follow-up was 2.3 years (range, 6 months to 8.3 years). Sixty-six eyes (97.0%) experienced improvement of signs and symptoms after 1 injection. Twenty-four months after a single injection, 67.6% of eyes remained recurrence-free, whereas at 48 months, 50.2% were recurrence-free. Some 55.0% of patients who had adverse effects from systemic medications were off all systemic medications at last follow-up; 55.0% of patients who were taking systemic medications at the time of first triamcinolone acetonide injection were not taking prednisone and immunosuppressants at this time; 76.2% of patients still requiring systemic agents had associated systemic disease. Fourteen eyes (20.6%) had ocular hypertension not requiring intraocular pressure (IOP)-lowering therapy. Two eyes (2.9%) were treated with topical IOP-lowering agents alone, and 2 eyes required surgical intervention for glaucoma. None developed scleral necrosis or melt. Conclusions: This retrospective, international study carried out at 9 hospitals suggests that STI can treat non-necrotizing, noninfectious anterior scleritis with side effects limited to elevated IOP in a few patients. Although no cases of scleral melt or necrosis were observed, we cannot definitively conclude that this may not occur after STI. Intraocular pressure should be closely monitored after STI. Subconjunctival triamcinolone acetonide injection may be useful as adjuvant therapy or to decrease systemic medication burden. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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