PSEUDO NECROTIZING SCLERITIS FOLLOWING IMPROPER ADMINISTRATION OF POSTERIOR SUB TENON INJECTION: CLINICAL PRESENTATION AND AS-OCT FEATURES
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Date
2024-07
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Era's Lucknow Medical College & Hospital, Lucknow in association with American University of Barbados (AUB)
Abstract
We present a case of pseudo necrotizing scleritis (NS,) following inadvertent subconjunctival administration of triamcinolone acetonide. Clinical presentation imitated that of necrotizing scleritis, with features of ulceration and episcleral inflammation. Diagnostic curratge of the lesion ruled out infectious etiology with infiltration of inflammatory cells. Anterior segment optical coherence tomography (AS-OCT) of the lesion was helpul in localizing ruling out true scleritis. Herein we define and highlight the unreported features of pseudo NS as imaged by AS-OCT. A 34 year-old female patient, presented to us two weeks following an intraocular injection performed elsewhere for macular edema. Clinical examination of the anterior segment was suggestive to conjunctivo-scleral necrosis while the fundus examination revealed an active subfoveal choroidal neovascular membrane (CNVM). Taking into consideration the clinical diagnosis and due to the lack of supportive documentation we assumed that the patient had probably received a dose of intra vitreal antivegf. A presumptive diagnosis of NS following needle prick was made, pathological evaluation of the ulcer alongside the OCT features aided in ruling out true NS. The pathological evaluation of the specimen revealed presence of connective tissue with macrophages and triamcinolone particles. AS-OCT showed involvement of the conjunctiva and episleral tissue with no scleral edema or thickening. Improper administration of peri ocular triamcinolone can cause conjunctival necrosis and can imitate necrotizing scleritis, AS-OCT evaluation of the lesion can be helpful in differentiation from true scleral necrosis.
Description
Keywords
Scleritis, OCT, Necrotizing Scleritis, Triamcinolone.
Citation
Kohli Gaurav, Singh Luxmi, Nigam Bharti . PSEUDO NECROTIZING SCLERITIS FOLLOWING IMPROPER ADMINISTRATION OF POSTERIOR SUB TENON INJECTION: CLINICAL PRESENTATION AND AS-OCT FEATURES. Era's Journal of Medical Research. 2024 Jul; 11(1): 128-132