Intravenous Catheter Employed in Peritrochlear Injection of Triamcinolone in the Treatment of Trochleitis.

Abstract:

PURPOSE:Injection of corticosteroid into the peritrochlear region is a widely practiced and highly successful treatment option for trochleitis, conventionally using a 25- or 27-gauge needle for the steroid injection. Injection into the vascular-rich peritrochlear region poses a risk, albeit rare, of central retinal artery occlusion or orbital hemorrhage. We describe a potentially safer method of delivering triamcinolone to the peritrochlear region using a 24-gauge intravenous catheter. METHODS:Interventional retrospective case series including all patients who received peritrochlear injections of triamcinolone via intravenous catheter for trochleitis by a single surgeon (BJW). SURGICAL TECHNIQUE:After a subcutaneous wheel of local anesthetic was delivered to the medial upper eyelid skin nearest to the trochlea, a 24-gauge intravenous catheter was used to penetrate the skin and orbital septum. Once past the septum, the needle was removed and the blunt catheter was advanced into the peritrochlear region. A 1-ml syringe filled with 40 mg/ml triamcinolone was attached to the catheter. After pulling back to ensure that the catheter was not intravascular, triamcinolone was delivered to the orbit. The catheter was then removed. RESULTS:Ten catheter injections were performed on 3 patients over an 8-year period. There were no complications. CONCLUSION:Injection of corticosteroid into the peritrochlear region using the commonly available 24-gauge intravenous catheter is an effective and theoretically safer alternative to typical injection using a 25-gauge needle for treatment of trochleitis. Use of nonparticulate steroid solutions may further decrease the risk of adverse events.

authors

Rubenstein JA,Chang CC,Idowu OO,Winn BJ

doi

10.1097/IOP.0000000000001826

subject

Has Abstract

pub_date

2020-08-24 00:00:00

eissn

0740-9303

issn

1537-2677

pub_type

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