Retrobulbar Injection With Triamcinolone Acetonide Forposterior Scleritis

Background:Posterior scleritis is an uncommon disease,it can cause changes in the normal structure of the eye. It is easy to be misdiagnosed and missed,because of its various clinical manifestations.Since 1960, the report on the posterior scleritis gradually increased.In recent years,because of the development in associated examination and ophthalmologic drugs,we have a better understanding about diagnosis and treatment of this disease. In the treatment of this disease,we use corticosteroids and nonsteroidal anti-inflammatory agents.And in severe cases we also use immunosuppressant. For the light condition, treatment with topic corticosteroids is usually effective. Triamcinolone acetonide (TA) is long-acting corticosteroids,it can be used to treat posterior scleritis through retrobulbar injection.Objective:To evaluate the therapeutic efficacy of retrobulbar injection with triamcinolone acetonide (TA) for posterior scleritis.Methods:Retrospective study 17eyes of 17 patients with posterior scleritis.The clinical data of 17 patients (17 eyes) with posterior scleritis were collected and examined in our hospital from January 2007 to January 2011.Retrobulbar injection with TA 20mg was performed on 17 eyes,applied one time weekly for 2-3 months.The visual acuity,fundus,intraocular pressure,B scan,fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were recorded and analyzed before and after treatment.The follow-up duration was 3 months-one year.Results:All patients after the intensive treatment redness,pain and other symptoms disappeared.Visual acuity was improved at the end of follow-up in 12 eyes (70.6%) and unchanged in 5 eyes (29.4%).The average visual acuity was 0.79 at the end of follow-up and 0.32 before treatment.The difference was statistically significant(P<0.05).The posterior sclera thickness of B scan was (1.25±0.45) mm at the end of follow-up and (4.35±1.55) mm before treatment. The difference was statistically significant(P<0.05). The posterior sclera and fascia edema disappeared. The result of FFA showed decrease of fluorescein leakage.The result of OCT showed overall reattachment of the sensory retinal,retinal edema disappeared, and choroidal folds disappeared. During follow-up,intraocular pressure of all patients was in the normal range.Recurrence of posterior scleritis was found in 2 eyes 3 to 6 months after treatment.Discussion:Posterior scleritis refers to inflammation of sclera,involving postequatorial eyeball and optic nerve's surround.It tends to affect middle-aged person;affects women more commonly than men,and is unilateral in most patients. Symptoms of posterior scleritis include pain and decreased vision with little or no redness.Its important clinical sign is fundus changes,include optic nerve head edema,serous retinal detachment,and choroidal folds.The cause is not known.It may be immunologically mediated or,less commonly,the result of infection. Posterior scleritis may be diffuse or local,it is a disorder characterized by cellular infiltration,destruction of collagen,and vascular remodeling. B scan,fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) are essential guide for diagnosis and differential diagnosis,and evaluate the therapeutic efficacy.Treatment with systemic or topic corticosteroids,nonsteroidal anti-inflammatory agents,or im mun osupp ressive agents is usually effective.Triamcinolone acetonide (TA) is long-acting corti costeroids,its effect lasts for about 2-3 weeks.The relative potency of TA to prednisolone is 20-30 times. TA is commonly used in retrobulbar and introglobular injections.All patients was unilateral in this group,and they were pain,visual acuity was reduced.All fundus changes included choroidal folds,optic nerve head edema,and serous retinal detachment.Three patients were complicated with rheumatoid arthritis. Retrobulbar injection with TA 20mg was performed on all patients, applied one time weekly for 2-3 months. All patients after the intensive treatment redness,pain symptoms disappeared.There were five patients which visual acuity cound not be improved,because of choroidal atrophy or optic atrophy.Other patients had greatly improved in visual, acuity,fundus also returned to normal.At the same time,the method which retrobulbar injection with TA treat posterior scleritis avoided systemic side effects of corticosteroids,and reduced the pain of frequent injections with short-acting corticosteroids,example dexamethasone.Conclusions:1,Retrobulbar injection with TA is a effective method to treat posterior scleritis.2,Retrobulbar injection with TA is a safe and easy treatment of posterior scleritis,no severe systemic side-effects of glucocorticoid and local injection of complications.