July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Modified Anterior Sub-Tenon’s Periocular Steroid Injection for Treatment of Intraocular Inflammation and Cystoid Macular Edema
Author Affiliations & Notes
  • Kenneth McKay
    Ophthalmology , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • Durga S Borkar
    Ophthalmology , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
    Ophthalmology, Wills Eye Hospital, Philadelphia, Pennsylvania, United States
  • Duriye Sevgi
    Ophthalmology , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • George Papaliodis
    Ophthalmology , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • Lucia Sobrin
    Ophthalmology , Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Kenneth McKay, None; Durga Borkar, None; Duriye Sevgi, None; George Papaliodis, None; Lucia Sobrin, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3510. doi:
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      Kenneth McKay, Durga S Borkar, Duriye Sevgi, George Papaliodis, Lucia Sobrin; Modified Anterior Sub-Tenon’s Periocular Steroid Injection for Treatment of Intraocular Inflammation and Cystoid Macular Edema. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3510.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To compare the safety and efficacy of traditional transseptal periocular steroid injection with a modified anterior sub-Tenon’s injection (ASTI) for treatment of intraocular inflammation and cystoid macular edema (CME).

Methods : Non-randomized, retrospective comparative study of seventy-nine patients who received transseptal steroid injection with thirty-six patients who underwent modified ASTI for intraocular inflammation or CME. Patients were assessed at 1, 3 and 6 month follow up. Outcome measures were rate of IOP rise, and necessity for cataract and glaucoma surgery within 1 year as well as visual acuity at 6 months, resolution of intraocular inflammation at 1 month, and CMT at 6 months.

Results : There was no significant difference in adverse outcomes between the transseptal group and the modified ASTI group. At 1 year, similar rates of cataract surgery (11% vs 12% respectively, p=1.00) were observed and no patients in either group required glaucoma filtration surgery. Rates of IOP rise trended higher in the modified ASTI group (25.0% vs 9%, p=0.08) with two patients experiencing refractory IOP rise. IOP normalized in both after removal of the steroid depot. Rate of necessity for IOP lowering therapy was identical in both groups. Mean visual acuity improved from 0.84 to 0.58 (p<0.001) in the transseptal group and 0.39 to 0.23 (p=0.002) in the modified ASTI group. Quiescence of vitritis 1-month post injection was similar in both groups (59% in the modified ASTI group and 50% in the transseptal group, p=0.57). CMT improved from 461µm to 367µm in the modified ASTI group. There was insufficient data for CMT analysis in the transseptal group.

Conclusions : The modified ASTI method appears to be an effective means for the control of intraocular inflammation and treatment of CME, demonstrating similar clinical efficacy to a more traditional injection method. While rate of IOP elevation was higher in the modified ASTI group, no patients required glaucoma filtration surgery and rare cases of refractory IOP rise achieved normalization with removal of the steroid depot.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

In the modified ASTI method, 0.4 to 0.5 cc of Kenalog 40 mg/ml is injected into the sub-Tenon’s space creating a visible steroid bleb. Injecting in this position allows for visualization of the needle and removal of the bleb in cases of severe IOP response.

In the modified ASTI method, 0.4 to 0.5 cc of Kenalog 40 mg/ml is injected into the sub-Tenon’s space creating a visible steroid bleb. Injecting in this position allows for visualization of the needle and removal of the bleb in cases of severe IOP response.

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