SUPRATARSAL INJECTIONS

VS TOPICAL STEROIDS IN
RESISTANT VERNAL
KERATOCONJUNCTIVITIS
Journal Reading
Tiara Nadya P
Pembimbing: dr. Retno Wahyuningsih, Sp.M
1810221029

Departemen Mata
RSUD Ambarawa
Fakultas Kedokteran UPN “Veteran” Jakarta
 ABSTRACT

Supratarsal
dexamethasone Supratarsal
sodium triamcinolone
phosphate acetoninde
Injection Injection

Topical
prednisolone
acetate 1%
ED

Safety & Efficacy

 INTRODUCTION

•Chronic
Vernal •Severe
Keratoconjuncti •Recurrent
vitis •Bilateral
seasonal allergic
(VKC) conjunctivitis
 INTRODUCTION
New treatment
Characterized Forms
modalities

Itching Palpebral Topical mast cell stabilizers

Photophobia Bulbar Topical forms of NSAID

Lacrimation Mixed Cyclocporine-A

Redness

Ropy discharge Supratarsal

Ineffective Steroid Injection
 Cobble stone

Corneal pannus Shield corneal ulcers

 PATIENT
Prospective study  120 eyes (60 patients) from March
2015 to May 2017, divided into 3 groups

Group 1
Group 2
40 eyes of 20
patients Group 3
40 eyes of 20
Supratarsal patients 40 eyes of 20
injection Supratarsal patients
Triamcinolone Injection
acetonide Topical
Dexametasone Prednisolone
Sodium Phosphate Acetate 1% ED

Inclusion Criteria
•Severe, recurrent & resistant VKC with
corneal manifestations (superficial
punctate keratitis (SPK), shield ulcer,
pannus)
•Free ocular examination other than
VKC, & its related manifestations
Exclusion Criteria
•Severe, recurrent & resistant VKC with
corneal manifestations (superficial
punctate keratitis (SPK), shield ulcer,
pannus)
•Free ocular examination other than
VKC, & its related manifestations
METHOD
Treatment for 2 weeks
• Artificial tears (carboxymethylcellulose 0,5%) ED 4x1
• Sodium cromoglycate 4% ED 2x1
• NSAID (bromfenac 0,09%) ED 2x1
• Olopatadine 0,1% ED 2x1
• Naphazoline hydrochloride 0,025% 4x1
• Pheniramine maleate 0,3% ED 4x1
• Cold compresses
• Avoiding exposure of sun & wearing dark glasses
Resistance
1 or more manifestation
• Persistent symptoms (redness, itching, photophobia,
lacrimation, whitish ropy discharge)
• Persistent papillae
• Persistent gelatinous limbal nodule w/wo Trantas’s
spots
• Persistent SPK
• Persistent shield corneal ulcer
• Progressive corneal pannus
 METHOD
Group 1 Group 2 Group 3

0.5 ml (20 mg) 0.5 ml (2 mg) 5x1 for 2 weeks

After injection & 2 weeks of steroid, therapy same as

preprocedure period
Followed up at 1 day, 1 week, 1 month, 3 months, 6
months & 12 months
 RESULTS
Table 1
Clinical signs Number of eyes Number of eyes Number of eyes
affected in G1 affected in G2 affected in G3
Palpebral form 28 26 28
(papillae)
Bular form 6 6 4
(limbal nodules)
Mixed form (palpebral, 6 8 8
bulbar)
Superficial Punctate 12 14 15
Keratitis
Shield Corneal Ulcer 5 4 4
Corneal pannus 15 17 16
G1 & G2 showed better resolution of
symptoms in comparison tp G3

G1 & G2 P > 0.05

G1 & G3 P < 0.05
G2 & G3 P < 0.05
In G3, recurrence started earlier
In G1 & G2 recurrence started
(at 3 months) & significantly
later at 6 months, G1 & G2
hhigher in cccomparison w/ the
(P > 0.05)
other two groups (P < 0,05)
 DISCUSSION

VKC is a common disease in hot climates

Resistant symptoms & signs  don’t respond to the usual treatment  severe 
blindness

Topical cyclosporin  weak effect on papillae & shield corneal ulcers

Surgical removal & cryo-application on resistant papillae   cicatrial complications

Holsclaw et al. Supratarsal steroid injection showed marked symptomatic relief w/

improvement of clinical sign
 Superiority of supratarsal Which when controlled, Supratarsal injection
injection over local steroids remission could be recurrence after 6 months
was its ability to decrease maintain by topical mast  longer period  better
local inflammation cell stailizers & NSAIDs quality of life

Intralesional steroid
In the current study, no
injection  chalazion or
systemic side effects from Sahu et al. Found longer
hemangioma  skin
Triamcinolone acetonide or relief period up to 24
depigmentation, subcutan
dexamethasone sodium months
tissue atrophy, retinal
phosphate
vascular occlusion

No complications were
reported in relation to the
injection itself or to the
injected drugs in the
present study
 CONCLUSION
 Supratarsal steroid injection (triamcinolone or dexamethasone)
in resistant cases of VKC is a safe, easy, and ef fective
technique  more ef fective & longer period of improvement of
symptoms & signs w/ a lower rate & delayed recurrence in
comparison to topical steroid ED
 The high clinical improvement w/ safe, easy & well -tolerated
method can improve the quality of life in resistant cases of
VKC
TERIMAKASIH