Abstract
Purpose :
To describe intraocular pressure (IOP) changes after injection of subtenon triamcinolone (Kenalog) (STK) during examination under anesthesia (EUA) for pediatric patients.
Methods :
This is a retrospective study of pediatric patients (age 18 years old or less) who received STK during EUA at Massachusetts Eye and Ear, Boston Children's Hospital, and Bascom Palmer Eye Institute by two providers (AMB and NAP) from November 2018 to October 2023. Patients with unavailable or elevated IOP (> 21 mmHg) at baseline, history of glaucoma, retinal detachment, ruptured globe, vitrectomy, scleral buckle, or lensectomy were excluded. IOP measurements at week 1 (day 1-13), month 1 (day 14-44), month 3 (day 45-135), and month 6 (day 135-225) following STK were recorded. Primary outcome included incidence of steroid-induced ocular hypertension (IOP > 21 mmHg and ≥ 5 mmHg increase compared to baseline). Secondary outcomes included incidence of moderate responders (IOP between 25-31 mmHg or a rise 10-15 mmHg from baseline) and high responders (IOP > 31 mmHg or a rise > 15 mmHg from baseline), incidence of newly diagnosed glaucoma, need for topical IOP-lowering agents or glaucoma surgery, and cataract formation.
Results :
42 out of 392 patients (10.7%) met the inclusion criteria. Laser was administered in 95.2% of cases. STK dose ranged from 4 to 20 mg (0.1 to 0.5 ml of 40mg/mL). The mean age at examination was 4.69 ± 6.26 years (0 - 19 years). 8 patients (19.0%) received multiple STK injections with a mean of 1.2 ± 0.42 additional injections within 6 months of the initial injection. Average time to the second injection was 78.5 ± 49.4 days (28 – 173 days). 3 patients (7.1%) were mild steroid responders with increase in IOP first reported between 110 and 142 days after STK. [VD1] 1 patient (2.4%) was a moderate responder at 131 days after STK. There were no high steroid responders, and all eyes with steroid response showed a return of IOP to normal range at the next follow-up visit without the need of IOP-lowering medications. No patients were diagnosed with glaucoma or required glaucoma surgery. 1 eye (1.6%) developed trace posterior subcapsular cataract.
Conclusions :
Subtenon triamcinolone injection is used to prevent inflammation during retinal photocoagulation treatment in pediatric patients. It has a favorable safety profile in relation to intraocular pressure elevation and cataract formation.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.