Injection Of Triamcinolone Acetonide Research Articles

Effectiveness of Suprachoroidal Injection of Triamcinolone Acetonide in Diabetic Macular Edema Following Pars Plana Vitrectomy Using a Modified Custom Microneedle.

The present study evaluated the efficacy of suprachoroidal injection of Triamcinolone Acetonide (SCTA) in diabetic macular edema (DME) following pars plana vitrectomy (PPV) using a modified microneedle. A prospective interventional study was conducted on 60 eyes of 60 patients with centrally involved diabetic macular edema following pars plana vitrectomy (PPV). SCTA was performed at the baseline and repeated after 3 months in case of persistent subretinal or intraretinal fluid, central macular thickness (CMT) more than 300 µm or visual loss by more than one line of the Snellen chart. The present study detected significant reduction of the CMT from 498.3 ± 94.8 µm at the baseline to 212.3 ± 11.9 µm after 12 months of injection with p < 0.001 and a significant improvement of best corrected visual acuity (BCVA) from 1 (0.9-1.2) at the baseline to 0.5 (0.3-0.7) after 12 months of injection with p < 0.001. The intraocular pressure (IOP) increased significantly after 3 months of injection with p < 0.001 and then gradually declined to its normal level after 6 months. Inner segment/outer segment (IS/OS) disruption was the only significant predictor of the final CMT; however, the number of injections, IS/OS disruption, baseline BCVA and the HbA1C level were the significant predictors of the final BCVA after injection. Suprachoroidal injection of TA using this microneedle resulted in significant anatomical and functional improvement in previously vitrectomized diabetic macular edema patients with no recorded ocular or systemic adverse events.

Effect of ultrasound-guided injection of botulinum toxin type A into shoulder joint cavity on shoulder pain in poststroke patients: study protocol for a randomized controlled trial

BackgroundHemiplegic shoulder pain (HSP) is a common complication after stroke. It severely affects the recovery of upper limb motor function. Early shoulder pain in hemiplegic patients is mainly neuropathic caused by central nerve injury or neuroplasticity. Commonly used corticosteroid injections in the shoulder joint can reduce shoulder pain; however, the side effects also include soft tissue degeneration or increased tendon fragility, and the long-term effects remain controversial. Botulinum toxin injections are relatively new and are thought to block the transmission of pain receptors in the shoulder joint cavity and inhibit the production of neuropathogenic substances to reduce neurogenic inflammation. Some studies suggest that the shoulder pain of hemiplegia after stroke is caused by changes in the central system related to shoulder joint pain, and persistent pain may induce the reorganization of the cortical sensory center or motor center. However, there is no conclusive evidence as to whether or not the amelioration of pain by botulinum toxin affects brain function. In previous studies of botulinum toxin versus glucocorticoids (triamcinolone acetonide injection) in the treatment of shoulder pain, there is a lack of observation of differences in changes in brain function. As the content of previous assessments of pain improvement was predominantly subjective, objective quantitative assessment indicators were lacking. Functional near-infrared imaging (fNIRS) can remedy this problem.MethodsThis study protocol is designed for a double-blind, randomized controlled clinical trial of patients with post-stroke HSP without biceps longus tenosynovitis or acromion bursitis. Seventy-eight patients will be randomly assigned to either the botulinum toxin type A or glucocorticoid group. At baseline, patients in each group will receive shoulder cavity injections of either botulinum toxin or glucocorticoids and will be followed for 1 and 4 weeks. The primary outcome is change in shoulder pain on the visual analog scale (VAS). The secondary outcome is the assessment of changes in oxyhemoglobin levels in the corresponding brain regions by fNIRS imaging, shoulder flexion, external rotation range of motion, upper extremity Fugl-Meyer, and modified Ashworth score.DiscussionUltrasound-guided botulinum toxin type A shoulder joint cavity injections may provide evidence of pain improvement in patients with HSP. The results of this trial are also help to analyze the correlation between changes in shoulder pain and changes in cerebral hemodynamics and shoulder joint motor function.Trial registrationChinese clinical Trial Registry, ChiCTR2300070132. Registered 03 April 2023, https://www.chictr.org.cn/showproj.html?proj=193722.

Evaluation of combined epiretinal membrane removal with intravitreal triamcinolone injection utilizing ectopic inner foveal layer staging scheme.

To investigate the macular morphological and visual outcomes of combined idiopathic epiretinal membrane (iERM) removal with triamcinolone acetonide (TA) injection based on consideration of the ectopic inner foveal layer (EIFL) staging scheme. Retrospective case-control study. The clinical data of 84 eyes of 84 patients who underwent vitrectomy for iERM between 2018 and 2022 were reviewed. The enrolled subjects were divided into the TA and non-TA groups. Fifty-one eyes received intravitreal TA injection following vitrectomy and ERM peeling (TA group), and 33 were only treated by standard vitrectomy and ERM peeling (non-TA group). Preoperative and postoperative EIFL stages, central foveal thickness (CFT), and best-corrected visual acuity (BCVA) were compared between both groups. After a mean follow-up of 7.69 ± 3.68months, both groups exhibited significant improvement in EIFL stages (P < 0.01), with no discernible advantage observed in the TA group. The TA and non-TA groups demonstrated improvement in the EIFL stages in 56.86 and 63.64% of eyes, respectively (P = 0.43). The CFT and BCVA significantly improved in both groups at the final visit (P < 0.01). However, CFT in the non-TA group displayed a more significant reduction during the follow-up (P < 0.03). Subgroup analysis revealed no significant differences in postoperative CFT and BCVA between the two groups in cases with or without continuous EIFL (P > 0.10). Our findings indicate that combined intravitreal TA injection following ERM removal conferred no significant benefits in alleviating macular thickening or improving visual acuity in iERM.

Fibrotic reaction to hyaluronic acid fillers in the face.

Hyaluronic acids (HAs) can have very different actions not only depending on injector and host factors but also depending on their molecular weight. Whereas short chain HA has immunological activity long chain HA influences fibroblasts and may stimulate them to produce collagen. Although this is generally thought to be a positive feature it may be disadvantageous in certain localizations. We have encountered 23 patients who developed fibrous tissue next to the nasolabial folds accentuating them and becoming very obvious while smiling. Hyaluronidase injection did not reduce this mass. Intralesional triamcinolone acetonide injection led to rapid improvement. Fibrotic tissue reaction not responding to hyaluronidase may be the result of HA injection and can effectively be treated with intralesional steroid injection.

Efficacy of acupoint injection in the treatment of chronic eczema and its influence on peripheral blood T cells.

Chronic eczema significantly impacts daily life, social interactions, and quality of life; however, no curative treatment has been identified. To determine the clinical efficacy of acupoint injection for chronic eczema and its influence on peripheral blood T cells. Eighty patients with chronic eczema treated at our hospital between June 2022 and March 2023 were randomly assigned to a control group (n = 40), which received conventional Western medicine treatment, or an observation group (n = 40), which received routine Western medicine treatment plus acupoint injection of triamcinolone acetonide. Response and adverse reaction rates, as well as differences in the levels of serum cytokines IFN-γ, IL-2, IL-4, and IL-10 before and after treatment were investigated. No difference in overall response rates were found between the observation and control groups (100% vs 90%, respectively; P > 0.05); however, the observation group had a higher marked response rate than the control group (87.5% vs 52.5%; P < 0.05). Both groups had decreased Eczema Area and Severity Index scores and increased pruritus after treatment (P < 0.05), particularly in the observation group (P < 0.05). The observation group had an adverse reaction rate of 2.5% (1/40), which did not differ significantly from that of the control group (P > 0.05). The observation group exhibited higher post-treatment INF-γ and IL-2 but lower IL-4 levels than the control group (P < 0.05); however, no significant inter-group difference was observed in post-treatment IL-10 levels (P > 0.05). Acupoint injection of triamcinolone acetonide is safe and effective in treating chronic eczema. Its therapeutic mechanism is related to the regulation of peripheral blood T cell levels, inhibition of inflammatory reactions, and mitigation of immune imbalance.

Comparative Outcomes of Propranolol Monotherapy and Combined Therapy with Intralesional Triamcinolone in Infantile Hemangioma

Background: Infantile Hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. Recently combined oral propranolol with intralesional injection of Triamcinolone acetonide is the effective method of treatment for infantile Hemangioma with minimal adverse effects. Objectives: To observe the outcome of Propranolol monotherapy and combined therapy with intralesional Triamcinolone in Infantile Hemangioma. Materials and Methods: This prospective study was carried out in the Department of Pediatric Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, during the period from January 2018 to December 2019. It included 42 infantile hemangioma patients divided into two groups: Group A (21) treated with oral propranolol, and Group B (21) treated with oral propranolol plus intralesional triamcinolone acetonide. Patients were followed up at regular intervals for 6 months. Results: The data of two groups of patients with IH were compared in the study. The demographic variables, including median age, sex, size, type, and site of IH, were comparable between the two groups. This showed that pre-treatment complications were slightly higher in Group B but not significantly different. Superior size reduction was observed in Group B (71.4% vs. 38.1%), though the difference was not significant statistically. Group B had excellent color regression, which was significantly higher compared to the other group (90.5% vs. 9.5%, p &lt; 0.001). The mean treatment cost was higher in Group B, which was 187.86. taka compared to 124.76. taka in Group A (P value was &lt;0.001). In summary, Group B had better color regression of the pinprick but at a higher cost of treatment as compared to Group A, and other parameters were almost equal in both groups. Conclusion: Combined propranolol and intralesional Triamcinolone is more effective compared to propranolol alone in the treatment of IHs.

The biodistribution of triamcinolone acetonide injections in severe keloids: an exploratory three-dimensional fluorescent cryomicrotome study

Intralesional corticosteroid injections are a first-line treatment for keloids; yet clinical treatment results are highly variable and often suboptimal. Variation in triamcinolone acetonide (TAC) biodistribution may be an important reason for the variable effects of TAC treatment in keloids. In this exploratory study we investigated the biodistribution of TAC in keloids and normal skin using different drug delivery techniques. Fluorescent-labeled TAC suspension was administered into keloids and normal skin with a hypodermic needle and an electronic pneumatic jet injector. TAC biodistribution was represented by the fluorescent TAC volume and 3D biodistribution shape of TAC, using a 3D-Fluorescence-Imaging Cryomicrotome System. Twenty-one keloid and nine normal skin samples were analyzed. With needle injections, the mean fluorescent TAC volumes were 990 µl ± 479 in keloids and 872 µl ± 227 in normal skin. With the jet injector, the mean fluorescent TAC volumes were 401 µl ± 252 in keloids and 249 µl ± 67 in normal skin. 3D biodistribution shapes of TAC were highly variable in keloids and normal skin. In conclusion, TAC biodistribution in keloids is highly variable for both needle and jet injection. This may partly explain the variable treatment effects of intralesional TAC in keloids. Future research is needed to confirm this preliminary finding and to optimize drug delivery in keloids.

Intensive triamcinolone acetonide injection regimen can highly prevent stricture after extensive esophageal endoscopic submucosal dissection

Background This study aimed to investigate the utility of intensive triamcinolone acetonide (TA) injections after extensive esophageal endoscopic submucosal dissection (ESD). Methods This retrospective study included 27 lesions in 27 consecutive patients who underwent ESD (ulcers encompassing ≥3/4 of the esophageal circumference) and received TA injections without oral steroid administration. Groups A and B included patients undergoing ESD with and without complete circumferential resection, respectively. All patients received TA injections (100 mg/session) immediately after ESD. In Group A, weekly based TA injections were performed until near-complete ulcer epithelialization. In Group B, patients did not receive additional injections or received weekly or biweekly TA injections. The primary outcome was stricture rate, and the secondary outcomes were the proportion of patients requiring endoscopic balloon dilation (EBD) and the number of TA injections. Results Group A included 7 lesions, and Group B included 20 lesions. The median (range) tumor lengths were 40 (30–90) and 45 (30–110) mm in Groups A and B, respectively. In Group A, the median circumferential resection diameter was 40 (20–80) mm. The stricture rate and the proportion of patients requiring EBD were 0 (0%) in Group A and 1 (5.0%) in Group B. The number of TA injection sessions was significantly higher in Group A than in Group B (8 [5–25] vs 1.5 [1–3]; p < 0.001). Conclusions Intensive weekly or biweekly based TA injections might aid in preventing post-ESD stricture and the need for EBD in patients undergoing extensive resection involving the entire esophageal circumference.

Delayed Closure of Macular Hole with an Internal Limiting Membrane Flap After Intravitreal Triamcinolone Acetonide Injection: Case Report

Delayed Closure of Macular Hole with an Internal Limiting Membrane Flap After Intravitreal Triamcinolone Acetonide Injection: Case Report

Immediate response to intravitreal treatment for macular edema due to diabetes and retinal vein occlusion.

To objectively assess the immediate response to intravitreal treatment for macular edema and compare it across different agents. This retrospective, comparative study included patients with macular edema due to diabetic retinopathy (DME) or vein occlusion who were treated with intravitreal injections of either steroids (triamcinolone acetonide or dexamethasone sustained release implant) or anti-vascular endothelial growth factor antibodies (VEGF). The central retinal thickness (CRT) and the best corrected visual acuity (BCVA) were measured 1 day after the injection and compared with immediate pre-injection values. There were 79 eyes (57 patients) including 51 eyes with DME, 18 with branch retinal vein occlusion edema (BRVO-ME), and 10 eyes with central retinal vein occlusion edema (CRVO-ME). The intravitreal agents were triamcinolone acetonide (TA)(n = 15), dexamethasone sustained release implant (DEX)(n = 22), ranibizumab (n = 19), and bevacizumab (n = 23). Statistically significant improvement in CRT was seen in all injection groups (p < 0.05) while improvement in mean BCVA was significant only in the TA group (p = 0.009). The mean change in CRT was maximum with steroids than with anti-VEGFs; viz. 159.47 µ in TA, 115.45 µ in DEX, 86.10 µ in ranibizumab, and 78.78 µ in bevacizumab group. Least amount of change was noted in the spongy type of macular edema (18.73 µ) while improvement in mean BCVA was statistically significant only in the cystoid group (p = 0.01). Comparatively, steroid agents showed better immediate response to therapy than anti-VEGFs. Maximum reduction in central retinal thickness was seen following triamcinolone acetonide injection. Cystoid edema showed better immediate response than spongy retinal thickening.

Safety and Effectiveness of Intravitreal Brolucizumab Injection in Combination With Sub-Tenon's Capsule Triamcinolone Acetonide Injection for Polypoidal Choroidal Vasculopathy During the Loading Phase.

This study evaluated the safety and effectiveness of combining intravitreal brolucizumab injection with sub-tenon's capsule triamcinolone acetonide injection (STTA) during the loading phase for polypoidal choroidal vasculopathy (PCV). In this retrospective observational study, untreated patients with PCV receiving intravitreal brolucizumab injections with STTA during loading at Saitama Medical University Hospital's Eye Center from May 2021 to June 2022 were analyzed. Complete regression rates of polypoidal lesions were assessed using indocyanine green angiography 12 weeks post-treatment initiation. Nineteen patients (19 eyes) participated. Best-corrected visual acuity significantly improved at eight weeks compared to baseline. No significant intraocular pressure increases occurred throughout the loading phase, while central foveal and choroidal thickness significantly reduced at 4, 8, and 12 weeks. Subretinal fluid was present in all patients before treatment, rapidly resolving post-intravitreal brolucizumab injections and STTA, with residual rates of 36.8% (seven eyes) and 5.3% (one eye) at four and 12 weeks, respectively. Intraocular inflammation did not occur during the loading phase, and the complete regression rate of polypoidal lesions was 89.5% (17 eyes). Combining intravitreal brolucizumab injection with STTA during the loading phase may be one treatment option for PCV management.

Efficacy of Intralesional Methotrexate Injection versus Triamcinolone Acetonide in Nail Psoriasis: A-Systematic Review and Meta-Analysis

Introducion: Psoriasis is a chronic inflammatory skin disease that can affect many parts of the body. Psoriatic involvement of the nail bed or nail matrix results in nail psoriasis that is common. Patients with psoriatic nails have impaired quality of life due to the appearance of nails, and significant morbidity and functional impairments may arise in large cases. The management of nail psoriasis is challenging because it is usually time-consuming with unsure outcomes. The existing evidences suggest that intralesional injection are particularly effective for nail psoriasis. Current studies provide recommendations on the intralesional injection technique, recommending an optimal concentration of methotrexate (MTX), triamcinolone acetonide (TA), and cyclosporine but the comparison of these treatment was still limited. Objective: This study aimed to evaluate the efficacy of intralesional injections of MTX compared with TA in treating nail psoriasis using Nail Psoriasis Severity Index (NAPSI) score. Methods: A systematic literature search was performed using EBSCOhost, Scopus, ProQuest, ScienceDirect, SpringerLink, Elsevier Clinical Key, Cochrane library, ClinicalTrials.gov subgroups terms: “intralesional methotrexate injections for nail psoriasis”, “intralesional triamcinolone acetonide injections for nail psoriasis” and “NAPSI Score”. Three studies were included in the qualitative synthesis and meta-analysis. Results: The overall SMD in NAPSI scores after administration of intralesional injection of MTX and TA was -0.213±0.232 (95% CI = -0.667 to 0.241). The Q statistic value was -0.921 (p=0.357), indicating the insignificant difference in the effectiveness of both therapies. Conclusion: Both MTX and TA were effective in treating nail psoriasis based on the reduction of NAPSI score.

Botulinum toxin injection shows promise in nail psoriasis: A comparative randomized controlled trial

Nail psoriasis remains a challenging condition with limited satisfaction from current treatments. An increasing number of neuropeptides were reported in psoriatic tissue. To compare the efficacy of botulinum toxin A (BoNT-A) injection, triamcinolone acetonide (TA) injection, topical combination of vitamin D/steroid (VitD/steroid) and placebo in improving nail psoriasis. A 24-week randomized intraindividual comparative-controlled study involved participants with at least 4 psoriatic fingernails, each with a total target nail psoriasis severity index (NAPSI) score of at least 3 points. Nails were randomly received different treatments; intralesional BoNT-A injection at baseline, intralesional TA at baseline and eighth week, daily topical VitD/steroid application for 16weeks and placebo. Evaluation of 64 psoriatic fingernails showed a 40% reduction in the total target NAPSI score at 24weeks following BoNT-A injection (P=.001). BoNT-A significantly improved nail bed lesions more than TA and topical VitD/steroid (P=.038), with no reported serious adverse effects. Relatively small sample size; hand hygiene during the COVID-19 pandemic may interfere NAPSI score evaluation. BoNT-A injection emerges as a promising and effective therapy for nail psoriasis, providing sustained efficacy lasting up to 6months with a single injection.

Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology

To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

SUPRACHOROIDAL TRIAMCINOLONE ACETONIDE FOR REFRACTORY POSTOPERATIVE CYSTOID MACULAR EDEMA.

To investigate outcomes of suprachoroidal triamcinolone acetonide (XIPERE, Bausch + Lomb) for the treatment of refractory postoperative cystoid macular edema. Medical records of patients receiving suprachoroidal triamcinolone acetonide for postoperative cystoid macular edema were reviewed. Primary outcomes were visual acuity and central foveal thickness. A total of 32 eyes from 32 patients with a median (interquartile range) follow-up duration of 6 (2-7) months and 1 (1-2) suprachoroidal triamcinolone acetonide injection were included; 19 (59.4%) had a history of vitrectomy. The median (interquartile range) central foveal thickness decreased from 492 (379-629) µm to 267 (187-388) µm at 1 month (P < 0.001), 362 (218-521) µm at 3 months (P = 0.005), and 339 (206-514) µm at the final visit (P < 0.001). The median logarithm of the minimal angle of resolution visual acuity improved from 0.65 (0.48-0.97, 20/89) at baseline to 0.54 (0.35-0.88, 20/69) (P = 0.058) at 1 month, 0.54 (0.33-0.84, 20/69) at 3 months (P = 0.121), and 0.60 (0.33-0.88, 20/80) at the final visit (P = 0.021). Vitrectomized eyes had similar findings. Six eyes (18.8%) developed elevated intraocular pressure (>24 mmHg) (range: 25-49 mmHg) with a median intraocular pressure elevation of 13.5 mmHg compared with baseline, and all had prior glaucoma or ocular hypertension. Suprachoroidal triamcinolone acetonide reduced macular edema and improved vision in refractory postoperative cystoid macular edema, including vitrectomized eyes. Intraocular pressure should be monitored, especially in those with a history of glaucoma or ocular hypertension.

Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery

PurposeTo compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) to postoperative topical prednisolone acetate (PA) with and without nonsteroidal anti-inflammatory drug (NSAID) for cataract surgery prophylaxis DesignRetrospective comparative effectiveness cohort study ParticipantsPatients undergoing phacoemulsification cataract surgery at Kaiser Permanente Northern California from 2018 through 2021 InterventionAnti-inflammatory prophylaxis exposure groups included topical PA with or without NSAID, and subconjunctival injection of TA (Kenalog®) 10 mg/mL or 40 mg/mL in low (1.0 - 3.0 mg) or high dose (3.1 - 5.0 mg). Main Outcome MeasuresThe adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of postoperative macular edema (ME) and iritis diagnoses 15 to 120 days following surgery (effectiveness measures) and a glaucoma-related event (safety measure) between 15 days to 1 year after surgery ResultsOf 69,832 eligible patient-eyes, postop ME, iritis, and a glaucoma-related event occurred, on average in 1.3%, 0.8% and 3.4% in the topical groups and 0.9%, 0.5% and 2.8% in the injection groups, respectively. In multivariate analysis, all injection groups had a trend of a lower OR of ME compared with the topical PA reference group, with the high dose TA 10 mg/mL group reaching statistical significance (OR 0.64, CI 0.43,0.97, P=0.033). The PA + NSAID group had higher odds (OR 0.88, CI 0.74,1.04, P =0.135). There was a trend of lower odds of a postop iritis diagnosis in the high strength (40 mg/mL) groups. For postop glaucoma-related events, compared with PA, the TA 10 mg/mL low dose group had lower odds (OR 0.69, CI 0.55,0.86, P=0.001), the TA 10 mg/mL high dose group had similar odds (OR 0.90, CI 0.70,1.15, P=0.40) and the TA 40 mg/mL low and high dose groups had higher odds (OR 1.46, CI 0.98,2.18, P=0.062), (OR 2.14, CI 1.36,3.37, P=0.001), respectively. ConclusionsThe TA 10 mg/mL high dose group, with an average dose of 4 mg, was associated with lower risk of postop macular edema and a similar risk of a glaucoma-related event compared with the topical groups.

A combination of suprachoroidal injection of triamcinolone using a custom-made needle and intravitreal Ziv-aflibercept every eight weeks to manage naïve/denovo central DME: a single-center retrospective case series

BackgroundPrevious studies have shown promising effects of combining intravitreal bevacizumab and suprachoroidal injection of triamcinolone acetonide in treating DME. However, further research is needed.ObjectiveTo assess the efficacy and safety of combining both intravitreal Ziv-aflibercept and suprachoroidal injection of triamcinolone acetonide using a custom-made needle in naïve and de novo central diabetic macular edema (DME) patients every eight weeks for 24 weeks.MethodsCentral macular thickness was measured via spectral domain-optical coherence tomography, and best-corrected visual acuity was measured via a Snellen chart at baseline and at 4, 8, 12, 16, and 24 weeks postinjection. Additionally, cataract progression, intraocular pressure (IOP), and ocular safety were analyzed.ResultsA total of 10 eyes of 6 patients were treated with suprachoroidal injections of triamcinolone acteonid combined with an intravitreal injection of Ziv-aflibercept. Vision improved from 0.69 log minimum angle of resolution (MAR) at baseline to 0.39 log MAR after treatment. Central macular thickness significantly decreased from 462.3 ± 166 μm at baseline to 362.7 ± 77.6 μm at 24 weeks postinjection.ConclusionSuprachoroidal injection of triamcinolone using a custom-made needle with the intravitreal agent Ziv-aflibercept to treat de novo/naïve central DME has favorable outcomes and adequate safety results. Moreover, this study demonstrated the benefit of adapting the previous treatment combination for extending the interval between anti-VEGF treatments from 4 to 8 weeks, which could prevent further expenses, especially in low-income countries.However, large multicenter randomized clinical trials with longer follow-up periods are needed to assess this treatment route, especially in low-income and resourced countries.

Pollybeak deformity in rhinoplasty: prevention and treatment.

Patients with pollybeak deformity who underwent rhinoplasty were analyzed retrospectively and across centers to identify their primary risk factors, preventative measures, and treatment modalities. The retrospective data of 100 pollybeak deformity cases (61 males and 39 females) were enrolled in our study. The causes leading to pollybeak deformity were evaluated and classified as (1) Over-resected bony dorsum, (2) Excessive supra tip scarring, and (3) Inefficient tip support causing an under-projected tip. The treatments applied to patients with pollybeak deformity were retrospectively evaluated and classified as (1) Triamcinolone acetonide injections (one or two injections), (2) Filler injection over the bony dorsum to balance, (3) Using a graft to achieve the desired nose shape, (4) Trimming down the excessive supra tip soft tissue and/or tip cartilage, and (5) Enforcing the tip support. Our results showed that the major cause of pollybeak deformity was excessive supra-tip scarring (48%). The other reasons are inefficient tip support, causing an under-projected tip (28%), and over-resected bony dorsum (24%). The modalities for the treatment of pollybeak deformity were (1) Trimming down the excessive supra tip soft tissue and/or tip cartilage (30%), (2) Triamcinolone acetonide injections (one or two injections) (28%), or (3) Enforcing the tip support (28%), (4) Using a graft to achieve the desired nose shape (14%) and (5) Filler injection over the bony dorsum to balance (6%). In some patients, more than one treatment modality was applied. Triamcinolone acetonide or filler injections were the non-surgical therapies for pollybeak deformities. We concluded that excessive supra-tip scarring is not directly related to a surgical error but rather depends on the patient and tissue healing. Care should be taken to avoid over-resecting the bony dorsum. Tip support should be provided to prevent inefficient tip support from causing an under-projected tip. However, efforts should be made to minimize supra-tip dead space and possibly proceeding pollybeak formation through proper bandaging.

Comparison between Two Doses of Suprachoroidal Triamcinolone Acetonide among Cases of Resistant Diabetic Macular Edema

Purpose: To compare the effectiveness and safety of two doses of supra-choroidal Triamcinolone Acetonide (TA)in patients of resistant diabetic macular edema. Study Design: Quasi experimental study. Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi, from April 2023 to September 2023. Methods: Thirty-two cases of resistant diabetic macular edema were selected using a convenient sampling technique and divided into two groups. Group A received a single suprachoroidal injection of TA at a concentration of 2 mg/0.1 ml, while Group B received the same drug via the same route at a concentration of 4 mg/0.1 ml. All cases were monitored for any serious adverse effects the following day. Follow-up checkups were conducted for all cases at 1, 3, and 6 months. Results: Mean age of patients for group A and B was 56.24±1.2and 56.33±2.6years respectively. Both the groups were equivalent in all ophthalmological measurements best corrected visual acuity, central macular thickness and intraocular pressure (BCVA, CMT, IOP) at baseline checkups. At 6thmonth follow up, both groups showed improved BCVA and decreased CMT compared to baseline, but group B had a significant increase in IOP (p = 0.001). Additionally, cataract progression was slower in group A. Conclusion: Both doses of suprachoroidal TA are equally effective in cases of resistant diabetic macular edema in terms of improved BCVA and reduced CMT. However, the lower dose (2mg/0.1 ml) showed advantages in terms of fewer complications, specifically less likelihood of raised intraocular pressure and cataract formation.

Effective Treatment of Keloids with Three-Dose Moderate-Strength Intralesional Triamcinolone Acetonide (TAC) Regimen

Background: The most devastating consequence of any injury is scar formation. Among all the surgical specialties, plastic surgery faces the worst dilemma as patients expect it to be the scar-less surgery.Objectives: This study aims to set an effective dose of triamcinolone acetonide intralesional injection to achieve successful results in the treatment of keloids.Methods: A prospective interventional study was conducted in the Department of Plastic Surgery, Shaikh Zayed Hospital Lahore for 2 years. Triamcinolone acetonide was injected intralesional at a dose of 4mg/cm2 every 4th week. The improvement in scar appearance, pain, and itch were measured using Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), and the St Andrew's itch egg scale, respectively up to 12 months of therapy.Results: Among the 40 patients, 12 were males and 28 were females. The mean age of patients was 32.8 years and the most common sites were the chest, earlobes, and back. There was a substantial progressive improvement in VSS and VAS scores over one year. A significant reduction in pruritus was also observed in the patients. No recurrence was noted at the end of 12 months.Conclusions: A moderate-strength dose of 4mg/cm2 as a single intralesional injection of triamcinolone acetonide every four weeks is effective in decreasing the size of keloids and relieving the symptoms such as pain and itching.