Supratarsal injection of triamcinolone acetonide and childhood allergic keratoconjunctivitis

Abstract

To evaluate the efficacy and safety of supratarsal injection of triamcinolone acetonide in the treatment of refractory allergic keratoconjunctivitis in childhood. Thirty-five patients (70 eyes) with severe allergic keratoconjunctivitis were included in this study. Fifteen patients (42.8%) had atopic keratoconjunctivitis (AKC) and 20 (57.2%) had vernal keratoconjuncivitis (VKC). All patients underwent a bilateral supratarsal injection of 20 mg triamcinolone acetonide. Mean follow-up was 28 months (range 14-38). All patients showed a significant symptomatic improvement and partial resolution of clinical features of keratoconjunctivitis within the first 2 weeks. Corneal complications related to keratoconjunctivitis disappeared in all patients. One patient with VKC experienced ocular hypertension. No patient with AKC showed side-effects. Severe relapse of the disease was noted in 10% of eyes with VKC and in 6.7% of eyes with AKC after a mean follow-up of 9 and 11 months, respectively. Supratarsal injection of triamcinolone acetonide is effective and safe in patients with severe chronic allergic keratoconjunctivits to relieve severe inflammation associated with this disease.

Treatment of asymmetrical vernal keratoconjunctivitis with supratarsal corticosteroid injection

“…In support of such an approach, previous studies have reported a ≥50% decrease in papillae size with complete healing of a shield ulcer 12 15. Injections are repeated when the disease recurs or is recalcitrant 15. In our patient, after two injected doses, there was a 100% decrease in papillae and the corneal erosion was totally healed.…”

“…Either short-acting dexamethasone or intermediate-acting triamcinolone are equally effective with a low risk of increased intraocular pressure 12 13. In support of such an approach, previous studies have reported a ≥50% decrease in papillae size with complete healing of a shield ulcer 12 15. Injections are repeated when the disease recurs or is recalcitrant 15.…”

Omalizumab in Severe Refractory Vernal Keratoconjunctivitis in Children: Case Series and Review of the Literature

“…However, a significant proportion of patients are intolerant to CsA, and 16% and 5% do not respond to this treatment at month 1 and 3, respectively [1]. There are very few options in these refractory cases: supratarsal steroid injections are very potent, but may induce severe iatrogenic complications [2]; systemic steroids may be used only for a limited time; tacrolimus 0.03% skin ointment is not approved for conjunctival application, although it seems to have a very interesting effect [3]; tacrolimus 0.1% eye drops are probably also potent, but are available only in few asian countries for the moment [4]; mild cryotherapy of papillae is also an option for some [5], but we believe that there is a risk of conjunctival atrophy and scarring after repeated applications.…”

A comprehensive review on vernal keratoconjunctivitis with emphasis on proteomics

“…In a large tertiary care center study in southern 85 India, majority of the patients presented at a mean age of 12 years. 86 Additionally, most of the patients presented with a mixed variety 87 disease (72%), with adult onset of the disease (first onset at or above 88 20 years of age) occurring in only 12% of cases [68]. developments in proteomics has been outlined in Table 1.…”

“…[33] Interferon-gamma secreted by Th1 cells has been implicated in In persistent and severe cases, supratarsal corticosteroid injection has 434 been used [86]. Aggressive limbal variants with papillae encroaching the 435 cornea can be treated by surgical excision [65].…”