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S. Majlessi, D.L. Parver, N.P. Shah, A. Palestine; Evaluation of Sub–Tenon Steroid Injections in an Office Setting to Treat Pediatric Uveitis . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5297.
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To evaluate the ability to deliver subtenon steroid injection in an office setting to treat pediatric uveitis.
A retrospective review of 21 eyes (13 patients) treated with subtenon steroid injections in the office setting by a uveitis specialist. Each sub–tenon steroid injection (STSI) consisted of 0.5cc Kenalog (40mg/ml) applied to the superotemporal subtenon space using a 27 gauge needle attached to a 1cc syringe. Prior to administration, each patient recieved topical proparacaine hydrochloride 0.5% as an anesthetic.
21 eyes (13 patients) underwent a total of 107 STSI with a range of 1–19 injections/eye (average 8 STSI/eye). There were 10 females and 3 males treated with average age of 11.5 years (range 2–22). Diagnoses included juvenile rheumatoid artheritis (7 patients), anterior iridocyclitis of unknown ideology (4 patients), and pars planitis (2 patients).86% of patients with JRA developed uveitis refractory to topical therapy while on systemic immunosuppression. Patients with iridocyclitis and pars planitis developed uveitis refractory to topical therapy while on systemic steroids. Adverse side effects or inability to perform the procedure were documented. All 107 STSI were successful with no complications noted at the time of injection.
In the pediatric population, STSI are generally given while the patients are under some form of regional or general anesthesia. In treating pediatric uveits, there is frequently a need for multiple STSI. This study illustrates that office administration of STSI under topical anesthesia is well tolerated and safe in the pediatric population. This study presents an alternative to other forms of anesthesia that have higher safety risks, require increased staffing and procedure time, and incur more expenses.
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