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| LETTER TO EDITOR |
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| Year : 2003 | Volume
: 51
| Issue : 3 | Page : 285 |
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Finer points about intravitreal corticosteroids
V Vedantham
Correspondence Address:
V Vedantham
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 14601865 
How to cite this article:
Vedantham V. Finer points about intravitreal corticosteroids. Indian J Ophthalmol 2003;51:285 |
Dear Editor,
I read with great interest the case report "Management of iatrogenic intravitreal triamcinolone acetonide" by Atul Kumar et al[1] reporting the successful management of accidental injection of the steroid into the vitreous cavity following a sub-Tenon's injection. I would like to clarify and supplement certain points mentioned in the article.
1. The potential complications of the injection could be attributed to the procedure itself or to the corticosteroid suspension. The former includes retinal detachment, vitreous haemorrhage and endophthalmitis and the latter includes glaucoma and cataract. The authors have mentioned that adverse reports of intravitreal corticosteroids have not been described. Although it is true that the safety of intravitreal steroids has been proven by various animal and human studies, recent reports have appeared (after acceptance of the publication of this case report in the IJO), describing complications such as glaucoma and cataract and even endophthalmitis. Jonas et al[2] have reported a case of secondary open angle glaucoma following intravitreal triam-cinolone injection wherein triamcinolone in both crystalline and soluble forms was found in the vitreous and aqueous humour respectively even at more than nine months following the injection. This suggests the need for a long follow-up of such patients.
2. It would be wise to follow certain precautions while giving a posterior subTenon's injection to prevent accidental globe perforation: (a) After insertion of the needle further manipulations of the needle into the subTenon's space should be made with wide side-to-side movements while watching the limbus. Movements of the limbus imply that the sclera has been engaged by the needle. (b) Before injecting it is important not to forget to withdraw the plunger of the syringe. If blood is aspirated it implies that the globe has been perforated by the needle tip. (c) After administering the injection, indirect ophthalmoscopy should always be performed in the quadrant of injection to rule out accidental intraocular injection of the drug.
3. It would probably be worthwhile to consider a planned primary intravitreal injection of corticosteroids under aseptic conditions in specific instances. While intravitreal injections have the advantage of getting distributed into a much larger volume, sub-Tenon's injections have been disadvantage of probably a decreased and difficult drug penetration through the sclera and choroid and a rapid removal by the choroidal circulation after penetration.
| References | |  |
| 1. | Kumar A, Prakash G, Nainiwal S. Management of Iatrogenic Intravitreal Triamcinolone Acetonide. Indian J Ophthalmol 2003;51:180-81.  [ PUBMED] [ FULLTEXT] |
| 2. | Jonas JB, Kreissig I, Degenring R. Secondary chronic open-angle glaucoma after intravitreal triamcinolone acetonide. Arch Ophthalmol 2003;121:729-30. [ PUBMED] [ FULLTEXT] |
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