Management of Intractable Steroid Induced Ocular Hypertension Following Posterior Subtenons Triamcinolone Acetonide Injection: A Case Report

Posterior sub-Tenon's (PST) injection of steroid has been used for the treatment of uveitis, cystoid macular edema and choroidal neovascularization. It allows high concentration of the drug to be delivered to the posterior segment of the eye via transscleral route with minimal systemic side effects. Triamcinolone acetonide is an aqueous suspension and it maintains a prolonged intraocular steroid concentration. Steroid-induced ocular hypertension is a complication often seen in patients treated with periocular steroid injections. We report a case of a twelve year old girl who was diagnosed with pars planitis in both eyes. As the inflammation could not be controlled with topical and oral steroids, she was given posterior subtenons triamcinolone acetonide injection. This led to rise in intraocular pressure (IOP) in both eyes. Fundus examination revealed normal optic nerve head in both eyes. The IOP in LE remained normal with anti glaucoma drugs, however in RE it could not be brought under control even with maximum topical and oral anti glaucoma medications. Thus PST implant in the RE was removed 4 months after its injection. The anti glaucoma medications were continued for 3 more months. IOP in RE came under control a month later. Surgical excision of PST should be considered as primary treatment in cases where IOP is not controlled despite maximum medical therapy. Patients with family history of glaucoma, primary open angle glaucoma, diabetes, connective tissue disorders and high myopia are at risk of developing steroid induced ocular hypertension.