Minimal Effect of Intra-Articular Corticosteroid Injection of the Knee on Human Subfoveal Choroidal Thickness

Abstract

Purpose : It has been well reported that systemic glucocorticoid exposure can trigger central serous chorioretinopathy (CSCR), and that increased choroidal thickness, also known as pachychoroid, is a characteristic of CSCR. However, it is still unknown if CSCR patients are born with pachychoroid or if pachychoroid is induced by steroid exposure. This study is designed to examine if intra-articular corticosteroid injections, a common treatment for joint pain, has any effect on the subfoveal choroidal thickness.

Methods : This was a prospective observational study. Patients undergoing a single 40 mg triamcinolone acetonide injection of the knee were enrolled. Subjects with prior exposure to any form of corticosteroids in the preceding 6 weeks or with pre-existing ocular disorders were excluded. All subjects underwent a baseline eye exam and optical coherence tomography (OCT) prior to their injection, followed by exams and OCT at 1 week, 1 month, and 2 months after the injection. Subfoveal choroidal thickness was measured using enhanced depth imaging (EDI) on Heidelberg OCT SPECTRALIS machines. Pre- vs post-injection choroidal thickness was compared using confidence intervals (CI) and one-way ANOVA.

Results : 10 eyes from 5 patients were included in the study. Patient demographics consisted of 2 male patients and 3 female patients, with an average age of 54.2 ± 6.3 years. Average percent change in subfoveal choroidal thickness, when compared to the pre-injection baseline, was +0.15% (95% CI [-1.38%, +1.69%]; p=1.00) at 1 wk, -0.06% (95% CI [-2.10%, +1.99%]; p=1.00) at 1 month, and +1.17% (95% CI [-0.14%, +2.48%]; p=0.354) at 2 months after injections. No significant difference in subfoveal choroidal thickness was observed in any of the 10 eyes in pre- vs post-injection comparison (p values varied from 0.347 to 0.912). There were no abnormal findings in comprehensive eye exams for any patients during the study period.

Conclusions : Intra-articular corticosteroid injections in the knee have minimal effect on subfoveal choroidal thickness and are not associated with visible changes in the choroid in this study. This study is limited in power due to a small sample size. Future studies with larger sample sizes are needed to confirm our results.

This is a 2020 ARVO Annual Meeting abstract.