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J. A. Dixon, J. L. Olson, V. D. Durairaj, N. Mandava; The Rate of Ptosis Following Subtenons Corticosteroid Injection. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5014.
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To estimate the incidence and the factors that play a role in the etiology of ptosis following sub-tenon’s corticosteroid injection.
Retrospective review of patients receiving sub-tenon’s corticosteroid injections and intravitreal anti-VEGF injections at a single institution between 2002 and 2007. The rates of ptosis in the two groups were compared using chi-squared analysis to determine the effect of sub-tenons corticosteroid placement on the development of ptosis. Patients undergoing intravitreal anti-VEGF injections were used as a control group because they received identical preparations and lid speculum placement, thus accounting for the role of the lid speculum in the development of ptosis. Patients were excluded from the study if they had a previous history of ptosis or recent eye surgery.
A total of 160 patients undergoing sub-tenons steroid injections and 425 patients undergoing intravitreal anti-VEGF injections were included in the study. The average ages of the two groups were 54.7 years and 65.6 respectively. There were 67 males and 83 females in the sub-tenon’s steroid group and 204 males and 219 females in the intravitreal injection group. A total of 8 patients (6.34%) receiving sub-tenon’s steroid injection and 2 patients (0.47%) receiving intravitreal injections developed ptosis (X2=11.44, p=0.0007). The relative risk of developing ptosis after sub-tenon’s steroid injection was 13.5 when compared with the intravitreal injection group (95% CI, 3<RR<60.9). The average number of injections per patient in sub-tenon’s group was 1.58 as a whole and 1.35 among those who developed ptosis. In the intravitreal group, the average was 3.9 injections per patient and 2 injections per patient in those with ptosis. The average time to presentation of ptosis in the two groups was 4.5 months and 2.5 months respectively.
A statistically significant greater incidence of ptosis was observed following sub-tenon’s steroid injection when compared to a control group of patients receiving intravitreal anti-VEGF therapy. This result is consistent with previously published case series identifying a direct effect of corticosteroids or its vehicle on the development of ptosis when injected in the sub-tenon’s space.
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