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Intraocular Pressure Elevation After Posterior Subtenon Triamcinolone Acetonide Injection in Pediatric Non-Infectious
Kubra Ozdemir Yalcinsoy1, Pinar Cakar Ozdal1, Emine Sen1
1Department of Ophthalmology, University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Türkiye.
Insights
Posterior subtenon triamcinolone acetonide (PSTA) injections can cause elevated intraocular pressure (IOP) and glaucoma in pediatric uveitis patients. Careful risk-benefit assessment is crucial before administering PSTA to children.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Glaucoma Research
Background:
- Pediatric uveitis is a significant cause of vision loss in children.
- Posterior subtenon triamcinolone acetonide (PSTA) is used to manage non-infectious uveitis.
- Steroid-induced ocular hypertension is a known complication of corticosteroid therapy.
Purpose of the Study:
- To evaluate the incidence of elevated intraocular pressure (IOP) and glaucoma in pediatric patients with non-infectious uveitis after PSTA injection.
- To assess the management and outcomes of steroid-induced IOP elevation in this population.
Main Methods:
- Retrospective evaluation of 26 pediatric patients (<18 years) with active uveitis.
- Exclusion of patients with pre-existing high IOP or prior subtenon/intraocular steroid exposure.
- Recording of IOP values before and after PSTA injection and subsequent treatments.
Main Results:
- 48% of eyes (19/40) experienced elevated IOP (≥21 mmHg) post-PSTA, with a mean peak IOP of 32.9 mmHg.
- Transient IOP elevation was managed with topical anti-glaucoma medications in 79% of affected eyes.
- Four eyes (21%) required filtration surgery (trabeculectomy with mitomycin C) due to uncontrolled IOP, and two eyes (11%) underwent subtenon deposit excision.
Conclusions:
- A significant rate of IOP elevation (47%) was observed after a single PSTA injection in pediatric non-infectious uveitis.
- Steroid-induced glaucoma can occur even after initial PSTA administration in pediatric uveitis.
- Management strategies including surgery and deposit excision are vital, and the risk-benefit profile of PSTA in children warrants careful consideration.
Objectives:
The objectives of the study were to evaluate non-infectious pediatric uveitis patients developing elevated intraocular pressure (IOP) and glaucoma following posterior subtenon triamcinolone acetonide (PSTA) injection.
Methods:
The data of 26 pediatric (<18 years) patients with active uveitis were retrospectively evaluated. Exclusion criteria were patients with a previous IOP >21 mmHg and previous subtenon or intraocular steroid injection. The IOP values of the patients before and after the PSTA injection and the treatments administered were recorded.
Results:
PSTA injection was used in a total of 40 eyes. The mean IOP was 14.0±2.3 (12-19) mmHg before PSTA. The IOP was elevated (≥21 mmHg) in 19 eyes (48%) after PSTA with a mean IOP of 32.9±11.7 mmHg (22-55). The mean interval time to IOP elevation was 3.3±1.9 weeks (1-8). The IOP was controlled in 15 eyes (79%) with topical anti-glaucomatous and these patients were considered as having transient IOP elevation. Trabeculectomy with mitomycin C was required in 4 eyes (21%) in whom the IOP could not be controlled despite the use of maximum topical medication and oral acetazolamide at a mean duration of 9.7±3.6 months (4-19). Subtenon deposit excision was performed in 2 eyes (11%). The mean IOP at the last follow-up was 16.0±2.4 mmHg (12-20).
Conclusion:
In our study, an IOP elevation rate as high as 47% was found in pediatric non-infectious uveitis patients following only a single PSTA injection. Steroid-induced IOP elevation and resistant glaucoma can develop even after the first PSTA administration in pediatric uveitis. Filtration surgery and the excision of subtenon triamcinolone deposits, when present, are important in glaucoma management. The risk/benefit ratio must be carefully considered when administering steroid injections to children with uveitis.
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