Intralesional corticosteroid injections as treatment for non-infectious orbital inflammation

Abstract

A retrospective single-center chart review identified 19 patients treated with intralesional corticosteroid injection between 2007 and 2015 for orbital inflammatory disease. Patients were treated in the office, or intraoperatively at the time of orbital exploration and biopsy, with 5-40 mg of triamcinolone acetonide. Average follow up time was 2.44 years. Information recorded included visual acuity and eyelid position measurements, pre-injection treatment, post-injection treatment, complications, and exam findings. Nine of the identified patients received intraoperative injections, 9 in the office setting, and one received an injection in each. Eight patients (42.1%) were on oral corticosteroids prior to the injection. All patients showed initial clinical improvement after 1-2 injections and no more than a 1-2 line difference in visual acuity. Overall, six patients (31.6%) required repeat injections due to recurrence of inflammation, and seven (36.8%) required additional oral corticosteroids beyond the initial taper. Patients pre-treated with oral corticosteroids were more likely to need repeat injections (83.3% vs 16.7% respectively, p = 0.04). Compared to injections performed in the office setting, intraoperative injections were associated with fewer repeat injections (0% vs. 60.0% respectively, p = 0.01) and less need for post-injection oral steroids (0% vs. 58.3% respectively, p < 0.01). There were no systemic or permanent side effects observed from the injections. Two patients (10.5%) had transient post-injection intraocular pressure elevation, which resolved. Intralesional orbital corticosteroid injection is an effective first-line and adjunctive treatment for localized and diffuse non-infectious orbital inflammation.

Non specific orbital inflammatory disease – A review article

“…It has also been found out that Intraorbital triamcinolone acetonide injection could be an effective treatment for IOI. 21 Systemic side effects of long term systemic corticosteroids include hyperglycemia, hypertension, weight gain, growth retardation, cushingoid features, osteoporosis, avascular bone necrosis and adrenal suppression, whereas glaucoma, cataract and herpetic corneal infection are ocular side effects. 22 Nonsteroidal anti-inflammatory drugs (NSAIDs) act by their anti-inflammatory effects by inhibiting cyclooxygenase pathway of prostaglandin synthesis.…”

Orbital Pseudotumor − Current State of Knowledge

“…Działanie takie, jednakże wiąże się z niebezpieczeństwem perforacji gałki ocznej, nadciśnienia śródgałkowego, owrzodzenia i martwicy spojówek oraz niedrożności tętnicy środkowej siatkówki. W celu zmniejszenia ryzyka tych powikłań acetonid triamcinolonu powinien być podawany w małych porcjach w wiele miejsc zajętego procesem zapalnym oczodołu [34] Radioterapia może być stosowana u pacjentów, którzy nie zareagowali na leczenie GKS lub w połączeniu z nimi. W jednym z badań, w którym zastosowano jednocześnie GKS i radioterapię odnotowano poprawę kliniczną u 87,5% pacjentów.…”

Idiopathic orbital inflammation: Review of literature and new advances

“…[ 7 ] Intraorbital triamcinolone acetonide injection has also been found to be an effective treatment for IOI. [ 39 ] Therefore, it appears that systemic corticosteroids may be effective as sole treatment in at least 40% patients with IOI and when combined with other immunosuppressants may show effect in about 60% of patients. Further, there may be a role for intraorbital corticosteroids either alone in combination with systemic corticosteroids.…”