Efficacy of posterior subtenon triamcinolone acetonide in presumed trematodal granulomatous uveitis: A prospective cohort study in Egyptian children and adolescents

PURPOSE: To evaluate the outcomes of posterior subtenon triamcinolone acetonide injections in patients with presumed trematode-induced granulomatous uveitis, including those treated with injection monotherapy and those receiving injections as part of combined therapy for high-grade disease. METHODS: A prospective interventional case series included 73 eyes of 68 patients with active anterior segment granulomas consistent with trematodal uveitis. Patients were stratified by disease severity using a published scoring system. Low-grade cases (score < 5) received initially topical anti-inflammatories. Eyes with persistent inflammation after 2 weeks received a posterior subtenon injection of triamcinolone; a repeat injection was given after 4 weeks if needed. High-grade cases (score ≥ 5) received subtenon triamcinolone injection. Surgical granuloma excision with anterior chamber wash was reserved for lesions with persistent inflammation 2 weeks after a second injection. RESULTS: Of 64 low-grade eyes, 32 (50%) required one subtenon steroid injection, and an additional 15 (23.4%) required a second injection. In this low-grade group, only 8 eyes (12.5%) ultimately required surgical excision after inadequate response to two injections. All 9 high-grade eyes (100%) were treated with subtenon triamcinolone from the outset. By 12 weeks, inflammation was controlled in 72 of 73 eyes (98.4%). CONCLUSIONS: Our study demonstrates that posterior subtenon triamcinolone injection is an effective therapy for trematodal granulomatous uveitis. This local steroid therapy was successful as a standalone intervention in the majority of cases (56 of 73 eyes, 76%), obviating the need for surgical excision.