Efficacy of subtenon steroid injection alone or in combination with topical steroid in the management of trematode-induced anterior granulomatous uveitis

Abstract

Background Presumed trematode-induced uveitis is a newly recognized cause of intraocular granulomatous inflammation in children, usually presenting with single or multiple pearl-like white nodules in the anterior chamber (AC) with or without subconjunctival lesions or corneal opacities. Objective The aim of this study was to evaluate the efficacy of subtenon steroid injection alone or in combination with topical steroid in the management of trematode-induced anterior granulomatous uveitis. Patients and methods This is a prospective comparative study, that included the children who presented with AC granulomas at the Uveitis Unit at Tanta Ophthalmology Hospital, Tanta, Egypt. The patients were divided into two groups: Group A, who received subtenon steroid injection only, and Group B, who received both subtenon steroid injection and topical steroid eye drops. The basic demographic data, visual acuity (VA), granuloma site and size, and AC activity (cells and flare) were recorded and analyzed. A systemic work-up, including stool and urine analysis, full blood count, chest X-ray, and schistosomiasis titer, was performed. The patients were followed up on the first day, at 2 weeks, 1, and 3 months Results The study included 30 eyes of 30 patients. The mean age of the patients was 13.4±2.42 years, and 87% of the patients were males. Group B patients demonstrated statistically significant better improvement in VA, AC activity, and granuloma site and size compared to Group A patients (P<0.001). The granuloma in group A did not change in size and continued to exhibit AC activity. Conclusion The combination of subtenon and topical steroid was found to be more effective in the treatment of granuloma than the subtenon injection alone.

Keywords

• anterior granulomatous uveitis
• management
• steroid injection
• subtenon
• topical
• trematode