A Case of Herpetic Keratitis after Subconjunctival Triamcinolone Acetonide Injection

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Abstract

Purpose

We report a case of herpetic epithelial keratitis that developed after subconjunctival triamcinolone acetonide injection (STI).

Methods

A 65-year-old female with anterior uveitis and hypotony in her right eye was given a STI (2 mg/0.5 ml). After the injection, she developed redness and an ocular discharge. A clinical examination was performed and real-time polymerase chain reaction (PCR) was used to amplify the viral DNA in a corneal scraping.

Results

Slit-lamp biomicroscopy revealed a severe purulent discharge, conjunctival injection, and a geographic corneal ulcer in the right eye. Herpes simplex virus 1 DNA was identified in the corneal scraping using real-time PCR. Herpetic keratitis was diagnosed and topical acyclovir ointment as well as systemic valacyclovir were started. The inflammation subsided with this medication.

Conclusion

We encountered a case of herpetic epithelial keratitis after a STI.

Related collections

Most cited references 11

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Long-term, multicenter evaluation of subconjunctival injection of triamcinolone for non-necrotizing, noninfectious anterior scleritis.

Chitti Moorthy, Narsing Rao, Hwa-Chain Wang … (2011)

We sought to characterize the long-term outcomes and complications of subconjunctival triamcinolone acetonide injection (STI) for non-necrotizing, noninfectious anterior scleritis. Retrospective, interventional, noncomparative, multicenter study. Sixty-eight eyes of 53 patients from 9 participating hospitals in the United States, Singapore, and Australia. Only eyes with 6 or more months of follow-up were included. Subconjunctival injection of 2 to 8 mg of triamcinolone acetonide was administered to eyes with non-necrotizing, noninfectious anterior scleritis. Resolution of signs and symptoms, time to recurrence of scleritis, and side effect profile. Median follow-up was 2.3 years (range, 6 months to 8.3 years). Sixty-six eyes (97.0%) experienced improvement of signs and symptoms after 1 injection. Twenty-four months after a single injection, 67.6% of eyes remained recurrence-free, whereas at 48 months, 50.2% were recurrence-free. Some 55.0% of patients who had adverse effects from systemic medications were off all systemic medications at last follow-up; 55.0% of patients who were taking systemic medications at the time of first triamcinolone acetonide injection were not taking prednisone and immunosuppressants at this time; 76.2% of patients still requiring systemic agents had associated systemic disease. Fourteen eyes (20.6%) had ocular hypertension not requiring intraocular pressure (IOP)-lowering therapy. Two eyes (2.9%) were treated with topical IOP-lowering agents alone, and 2 eyes required surgical intervention for glaucoma. None developed scleral necrosis or melt. This retrospective, international study carried out at 9 hospitals suggests that STI can treat non-necrotizing, noninfectious anterior scleritis with side effects limited to elevated IOP in a few patients. Although no cases of scleral melt or necrosis were observed, we cannot definitively conclude that this may not occur after STI. Intraocular pressure should be closely monitored after STI. Subconjunctival triamcinolone acetonide injection may be useful as adjuvant therapy or to decrease systemic medication burden. Proprietary or commercial disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Subconjunctival triamcinolone acetonide in the management of ocular inflammatory disease.

Yannis Athanasiadis, Michael Tsatsos, Anant Sharma … (2013)

To review the existing evidence that supports the subconjunctival use of triamcinolone acetonide (TA) in the treatment of various ophthalmic diseases.

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Risk of hypotony in noninfectious uveitis.

Ebenezer Daniel, Maxwell Pistilli, Siddharth S Pujari … (2012)

We sought to describe the risk and risk factors for hypotony in a noninfectious uveitis cohort.

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Author and article information

Journal

Journal ID (nlm-ta): Case Rep Ophthalmol

Journal ID (iso-abbrev): Case Rep Ophthalmol

Journal ID (publisher-id): COP

Title: Case Reports in Ophthalmology

Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )

ISSN (Electronic): 1663-2699

Publication date Collection: Sep-Dec 2014

Publication date (Electronic): 3 September 2014

Publication date PMC-release: 3 September 2014

Volume: 5

Issue: 3

Pages: 277-280

Affiliations

Department of Ophthalmology, Ehime University, Graduate School of Medicine, Toon, Japan

Author notes

*Takashi Suzuki, PhD, MD, Department of Ophthalmology, Ehime University, Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 (Japan), E-Mail t-suzuki@ 123456m.ehime-u.ac.jp

Article

Publisher ID: cop-0005-0277

DOI: 10.1159/000367582

PMC ID: 4209261

SO-VID: 9e80b137-34f5-4ad5-b813-bd47476bea55

License:

This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

History

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Figures: 2, References: 10, Pages: 4

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