Posterior sub-tenon injection of triamcinolone in non-resolving vitreoretinitis - A case report

Abstract

Purpose: To evaluate the efficacy of posterior sub-tenon injection of triamcinolone in non-resolving vitreoretinits. Introduction: Vitreoretinits is the inflammation of the vitreous and retina. In a non-resolving case of vitreoretinitis steroids are the mainstay of treatment. Steroids can be administered via various routes into the eye. Posterior subtenon injection of Triamcinolone acetonide is an effective treatment option for anatomical and functional improvement in intermediate and posterior uveitis. Methods: A 46-year-old female presented to the outpatient department with decreased vision in her left eye for 3 months. On examination, she had a BCVA of 6/60 in her left eye. Fundoscopy showed vitreous haze grade 3 due to vitritis, multiple vitreoretinal tractional bands extending along both the superior and inferior arcade, macular edema, and a retinitis patch of less than half disc diameter size just above the superior arcade. The patient was positive for IgG antibodies to Cytomegalovirus and Herpes Simplex virus. The patient was started on oral prednisolone 1mg/kgbw once a day and topical prednisolone acetate 1.0%, nepafenac 0.3%, and timolol 0.5%. The patient was given posterior subtenon injection of 0.5ml of triamcinolone acetonide 40mg/ml. Results: She had 6/12 BCVA at the end of 1 month with resolving vitritis and macular edema. By the end of 3 months, she had fully resolved vitreoretinitis with 6/6 vision. Discussion: Most steroids used in ophthalmology are glucocorticoids, which have anti-inflammatory and immunosuppressive activity. Triamcinolone Acetonide is a minimally water-soluble suspension. Triamcinolone crystals slowly dissolve into the vitreous. This creates a diffusional gradient from the vitreous to the macula with minimal systemic exposure. Our study also showed significant improvement in visual acuity and reduction in macular edema with a single posterior subtenon injection of triamcinolone acetonide. Conclusion: A subtenon injection of triamcinolone acetonide appears to be an effective treatment for decreased vision associated with intermediate and posterior uveitis without any significant side effects.