title: Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis.
abstract: OBJECTIVE
  We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, noninfectious anterior scleritis.
  
  
  METHODS
  Retrospective, interventional, noncomparative, multicenter study.
  
  
  METHODS
  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.
  
  
  METHODS
  Subconjunctival injection of 2 to 8 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, noninfectious anterior scleritis.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  Proprietary or commercial disclosure may be found after the references.
authors.affiliation: Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
authors.forename: Elliott H
authors.initials: EH
authors.lastname: Sohn
authors.forename: Robert
authors.initials: R
authors.lastname: Wang
authors.forename: Russell
authors.initials: R
authors.lastname: Read
authors.forename: Athena
authors.initials: A
authors.lastname: Roufas
authors.forename: Livia
authors.initials: L
authors.lastname: Teo
authors.forename: Ramana
authors.initials: R
authors.lastname: Moorthy
authors.forename: Thomas
authors.initials: T
authors.lastname: Albini
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Vasconcelos-Santos
authors.forename: Laurie D
authors.initials: LD
authors.lastname: Dustin
authors.forename: Ehud
authors.initials: E
authors.lastname: Zamir
authors.forename: Soon-Phaik
authors.initials: SP
authors.lastname: Chee
authors.forename: Peter
authors.initials: P
authors.lastname: McCluskey
authors.forename: Ronald
authors.initials: R
authors.lastname: Smith
authors.forename: Narsing
authors.initials: N
authors.lastname: Rao
mesh_terms: D000328:Adult; D000368:Aged; D000869:Anterior Eye Segment / Q000187:drug effects* / Q000382:microbiology; D003228:Conjunctiva / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D056965:Injections, Intraocular; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015423:Scleritis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide