Complications and safety profile of posterior sub-tenon triamcinolone injections in sclero-uveitis cases in a tertiary institute of northeast India

In this prospective, interventional, case series one uveitis expert conducted the investigation in an institutional set-up. Study was carried out from March 2009 to November 2014 in a tertiary institute of northeast India after ethical clearance from the Institutional Ethics Committee. All injections (40mg, 1.0mL of non-filtered Triamcinolone acetonide) were given with a disposable syringe, 25 gauges, 5/8-inch in supero-temporal quadrant (recommended by Nozik )5 after the informed oral consent from the patient. Topical anesthesia applied for one minute in the lower conjunctival sac in each of the case. Patient was asked to look away from the site of injection. Upper eyelid was elevated and cotton swab soaked in topical anesthetic drops placed over the injection site for about 15-20seconds. Bulbar side of the conjunctiva was chosen for the injection entry because of more visibility and more firm attachment to the Tenon’s capsule in that area so that sub-tenon’s space could be reached early and accurately. After everting the eyelid, penetration of needle was done in the bulbar conjunctiva (2-3mm from fornix) with the tip of needle’s bevel end facing towards the globe. Needle was inserted posteriorly while following the curvature of the eyeball, keeping a close look to the globe and the limbus. Wide side-to-side motions were done while the needle advanced gradually in sub-tenon space. Movement in the limbus during the side-to side movements would mean that we have penetrated the sclera which was undesirable. When needle had reached to maximum, twisting of the needle was done circumferentially until the bevel end reached the edge of the sclera. Plunger was withdrawn to see if any blood was coming out. If not then drug was injected in the posterior sub-tenon space. No white swelling was visible at the injection site in most of the uncomplicated cases. First post-injection check-up was done on 15th day. Patients were followed up for at least 3months after receiving the injections. All complications associated with the injection itself were noted. Pre-injection and post-injection IOP was measured with Goldman explanation tono meter. Most of the patients had been treated previously with topical and systemic steroids and the included eyes did not react with excessive increase of IOP.