June 2020
Volume 61, Issue 7
ARVO Annual Meeting Abstract  |   June 2020
Supero-temporal approach for Subtenon Kenalog injection
Author Affiliations & Notes
  • Richard T Atallah
    Ophthalmology , Rutgers New Jersey Medical School, New York City, New York, United States
  • Neelakshi Bhagat
    Ophthalmology , Rutgers New Jersey Medical School, New York City, New York, United States
  • Footnotes
    Commercial Relationships   Richard Atallah, None; Neelakshi Bhagat, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 319. doi:
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      Richard T Atallah, Neelakshi Bhagat; Supero-temporal approach for Subtenon Kenalog injection. Invest. Ophthalmol. Vis. Sci. 2020;61(7):319.

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

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Purpose : To advocate for the supero-temporal approach for subtenon Kenalog (STK) injection for its increased safety and efficacy profile.

Methods : A retrospective chart review of 10 patients from the retina clinic at University Hospital at Rutgers New Jersey Medical School between September 2017 – September 2019 who underwent STK by NB in the supero-temporal quadrant under direct visualization for cystoid macular edema. A TB syringe with a 26 – gauge needle was used; the tip of the needle was moved side-side to make sure there was no movement of the underlying globe verifying no scleral penetration. The eyes were examined for the presence of subtenon steroid depot at follow-up visits.

Results : Ten patients underwent STK using the supero-temporal approach technique. All received 40 mg of subtenon triamcinolone acetonide in the superotemporal position. The tip of the needle was seen in the subtenon space with direct visualization, before triamcinolone was injected in all cases. All eyes except 1 had the steroid deposit visualized in the subtenon space for over 3 months. The duration of Kenalog deposit after the injection lasted from 3 – 6 months in 9 eyes and for 8 weeks in one remaining eye. No complications of subconjunctival hemorrhage, or intraocular penetration were noted in any eye.

Conclusions : The ST technique of STK injection was able to deliver the medication in the correct location in all eyes and the depot lasted for 6 months in a few eyes. This technique seems to be safer than the more frequently used peribulbar infero-temporal approach to deliver STK. Globe penetration is highly unlikely with this directly visualized technique. The depot overhangs the macula posteriorly and may have additional benefit in release of triamcinolone closer to the targeted tissue.

This is a 2020 ARVO Annual Meeting abstract.



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