Repository corticotherapy in ophthalmic theory and practice

Abstract

(1) The various factors to be considered when placing a long-acting steroid in ocular tissues are discussed. (2) For anterior segmental lesions, a subconjunctival injection of 0 15 ml. of Depo-Medrone directly into the lower fornix is preferred. This will act for three weeks. (3) For posterior segmental lesions, after a retrobulbar injection of 0 50 ml. of 1-2 per cent. Lignocaine, 1 0 ml. Depo-Medrone (believed to last from two to four weeks) is injected down the same needle. (4) A subconjunctival deposit of Depo-Medrone recovered after 21 days from a human eye was unequivocally identified as active unchanged methylprednisolone acetate. (5) An injection of Depo-Medrone caused no appreciable harm to pieces of extrinsic ocular muscle and Tenon's capsule, the tissues being recovered fourteen days after the injections. (6) Apart from the many practical advantages of repository corticotherapy, this method of treatment was found to be more effective than topical therapy, and safer and cheaper than systemic, in several types of lesion, especially in anterior non-granulomatous or mixed uveitis, or certain auto-immune diseases, and chronic ulcers. (7) Where the lesion is inaccessible to topical therapy, as in posterior uveitis, or inflammatory conditions of the lacrimal passages, the repository technique is admirably suited. (8) The role of steroids in controlling hypersensitivity reactions is applied to the theories surrounding the aetiology of sympathetic ophthalmia, phakotoxic uveitis, some of the auto-immune diseases, and post-herpetiform keratitis and uveitis. In the case of the latter, the author concludes that post-herpetiform keratitis is a hyper-sensitivity reaction, but the uveitis is not, because the keratitis alone responds favourably to Depo-Medrone.