A prospective evaluation of subconjunctival injection of triamcinolone acetonide for resistant anterior scleritis

Purpose: Prospective evaluation of the efficacy and safety of subconjunctival triamcinolone injections for resistant, nonnecrotizing, anterior scleritis. Design: Prospective, noncomparative, interventional case series. Participants: Twelve eyes of 10 consecutive patients seen in the Doheny Eye Institute between August 1999 and December 2000 with diffuse, nonnecrotizing anterior scleritis that was resistant to systemic anti inflammatory therapy. Eyes with a history of steroid response were excluded. Intervention: Subconjunctival injection of triamcinolone acetonide to the areas of maximal inflammation. Main Outcome Measures: Scleritis activity, adverse treatment effects, and number of systemic medications required at the end of the follow-up period. Results: Within 1 to 14 days after injection, complete resolution of signs and symptoms was achieved in 11 eyes and partial resolution in 1 eye. Two patients had one recurrence each, 2.5 and 11 months after injection. Six of 10 patients were able to discontinue all systemic therapy (prednisone +/- immunosuppressive drugs); the remaining 4 needed continued oral therapy for systemic indications. Transient ocular hypertension and subconjunctival hemorrhage occurred in one eye each. Median follow-up period was 15 months. No eye developed necrotizing scleritis. Conclusions: Subconjunctival injection of triamcinolone acetonide is a safe and effective treatment for resistant, nonnecrotizing anterior scleritis. It provides rapid effect, is well tolerated, and may spare patients the significant complications and side effects of systemic corticosteroid and immunosuppressive therapy. (C) 2002 by the American Academy of Ophthalmology.