Safety of Suprachoroidal Triamcinolone Acetonide Injection without Cannula Sleeve: A Modified Technique

Purpose:  To evaluate safety of a new technique of Suprachoroidal (SC) injection of Triamcinolone Acetonide (TA) without need of cannula sleeve. Study Design:  Quasi experimental study. Place and Duration of Study:  LRBT Korangi from July 2020 to June 2021. Methods:  Fifty eyes of forty two patients with Diabetic Macular Edema not resolved with three consecutive intravitreal injection of Bevacizumab were included. A custom made 30 gauge needle on 1cc insulin syringe without cannula sleeve was used for injection of 0.1 ml (4 mg) Triamcinolone Acetonide. Results:  Mean age was 50.8 13.77 years. Mean IOP readings pre injection, after injection at 5 minutes, 30 minutes, 1 hour, 2 hour, 1 week, 1 month and 3 months were 12.76 , 14.8 , 14.5 , 14.6 4.46, 14.7 4.52,14.7 , 12.98  and 12.83 2.62 mm of Hg respectively. Mean BCVA (Log MAR) before injection, 1 month and 3 months after injection were 0.9 ± 0.1, 0.6 ± 0.2 and 0.6 ± 0.2 respectively. Mean CMT values before injection, 1 month and 3 months after injection were 408.4 ± 112.94, 348.67 ± 108.94 and 330.36 ± 105.77 µm respectively. Significant difference was observed between pre-injection IOP and post injection IOP within 2 hours but no significant difference in later readings. BCVA and CMT showed statistically significant improvement. Conclusion:  SC injection of TA without cannula sleeve is quite simple and apart from transient increase in IOP immediately after injection no significant adverse effects occur.