Periocular corticosteroid injection in the management of uveitis in children

Acta Ophthalmol. 2010: 88: e299–e304

Abstract.

Purpose: To report the outcome of orbital floor corticosteroid injection (OFCI) in the management of uveitis in children. Methods: A retrospective noncomparative interventional case series. The medical records of 15 consecutive children (19 eyes) with various forms of uveitis treated with OFCI of 40 mg/ml methylprednisolone acetate or a combination of 20 mg/0.5 ml Triamcinolone and 2 mg/0.5 ml dexamethasone were reviewed. Data were collected 6 months postinjection and included details of uveitis, best corrected visual acuity (BCVA), ocular inflammation, systemic therapy required and potential complications of OFCI. Results: The mean BCVA improvement was 0.18 logarithm of the minimum angle of resolution (p < 0.001), at a mean of 6 weeks (range, 4–20). Fourteen eyes (74%) had significant improvement in inflammation, 4–7 weeks post‐OFCI, with a median of 4 weeks. Anterior uveitis was treated effectively in all eyes, vitritis resolved in all but one case and resolution of cystoid macular oedema was achieved in six eyes (55%). Uveitis relapsed in seven eyes (50%) after a median time of 4 months (range, 2–5 months). Four eyes (21%) underwent more than one injection. The dosage of immunosuppressive systemic therapy was reduced or able to be stopped in three patients (50%). Steroid‐induced cataract was observed in four eyes (21%), 5 months post‐OFCI. One patient developed cushingoid features 6 weeks post his second OFCI. Conclusion: Corticosteroid orbital floor injections resulted in control of active uveitis and visual acuity improvement in most children. However, the effect might be transient and induce cataract formation.