Intraocular Pressure Elevation After Posterior Subtenon Triamcinolone Acetonide Injection in Pediatric Non-Infectious Uveitis

OBJECTIVES: The objectives of the study were to evaluate non-infectious pediatric uveitis patients developing elevated intraocular pressure (IOP) and glaucoma following posterior subtenon triamcinolone acetonide (PSTA) injection.
METHODS: The data of 26 pediatric (<18 years) patients with active uveitis were retrospectively evaluated. Exclusion cri-teria were patients with a previous IOP >21 mmHg and previous subtenon or intraocular steroid injection. The IOP values of the patients before and after the PSTA injection and the treatments administered were recorded.
RESULTS: PSTA injection was used in a total of 40 eyes. The mean IOP was 14.0±2.3 (12–19) mmHg before PSTA. The IOP was elevated (≥21 mmHg) in 19 eyes (48%) after PSTA with a mean IOP of 32.9±11.7 mmHg (22–55). The mean interval time to IOP elevation was 3.3±1.9 weeks (1–8). The IOP was controlled in 15 eyes (79%) with topical anti-glaucomatous and these patients were considered as having transient IOP elevation. Trabeculectomy with mitomycin C was required in 4 eyes (21%) in whom the IOP could not be controlled despite the use of maximum topical medication and oral aceta-zolamide at a mean duration of 9.7±3.6 months (4–19). Subtenon deposit excision was performed in 2 eyes (11%). The mean IOP at the last follow-up was 16.0±2.4 mmHg (12–20).
DISCUSSION AND CONCLUSION: In our study, an IOP elevation rate as high as 47% was found in pediatric non-infectious uveitis patients following only a single PSTA injection. Steroid-induced IOP elevation and resistant glaucoma can develop even after the first PSTA administration in pediatric uveitis. Filtration surgery and the excision of subtenon triamcinolone deposits, when present, are important in glaucoma management. The risk/benefit ratio must be carefully considered when administering steroid injections to children with uveitis.