Ml Of Triamcinolone Acetonide Research Articles

8239 Recurrent Superior Laryngeal Nerve Glucocorticoid Injections: A Likely Cause Of Secondary Adrenal Insufficiency In An Otherwise Healthy Man

Abstract Disclosure: A. Lorin: None. M.C. Pranger: None. J. Park: None. C.A. Clutter: None. Background: Secondary adrenal insufficiency is well described in the literature with various offending agents implicated. Superior laryngeal nerve (SLN) glucocorticoid injections, however, have rarely been recorded as causal agents of secondary adrenal insufficiency. We present a case of a generally healthy man with secondary adrenal insufficiency after chronic administration ofsuperior laryngeal nerve glucocorticoid injections without other identifiable etiologies. Clinical Case: A 68-year-old man with no significant medical history presented to endocrinology clinic due to persistent nausea and severe fatigue. His initial labs were notable for morning cortisol of 1.66 mcg/dL (5-25) and an undetectable ACTH (<3.2 pg/mL, 10-60) suggestive of adrenal insufficiency. FSH/LH, testosterone, FT4, and IGF-1 were otherwise normal. On initial review of his medication history, the only glucocorticoid exposure appeared to be intranasal beclomethasone, with remote courses of oral prednisone. Further history revealed that the patient was receiving superior laryngeal nerve glucocorticoid injections for chronic cough every three weeks for over a year. The injection consisted of 1:1 mixture of 1 mL of triamcinolone acetonide 200 mg/5 mL and local anesthetic, which is equivalent to triamcinolone 40 mg or hydrocortisone 200 mg. Given the volume and chronicity of the glucocorticoid injections, the patient developed secondary adrenal insufficiency as above. Since the diagnosis, the patient discontinued SLN glucocorticoid injections and was placed on physiologic hydrocortisone replacement, with gradual recovery of his HPA axis. Conclusions: Sequelae of percutaneous glucocorticoid injection into the superior laryngeal nerve for treatment of chronic cough are not well documented in terms of their effects on the HPA axis. While an effective and increasingly common treatment for chronic cough, SLN glucocorticoid injection has the potential to cause suppression of the HPA axis and cause secondary adrenal insufficiency. Excess glucocorticoid appeared to solely inhibit ACTH production, as the other anterior pituitary hormones were not affected. Understanding consequences of glucocorticoid use in any formulation is important when considering such therapies, as these may alter normal HPA function with recurrent dosing. Recovery from a disrupted HPA axis may be achieved with the use of physiologic doses of hydrocortisone replacement in the case of secondary adrenal insufficiency. Presentation: 6/3/2024

Effect of Averrhoa carambola L. on the Skin in an Animal Model of Hypertrophic Scarring

Introduction: Hypertrophic scarring in the skin represents a serious global public health problem, as it physically and emotionally affects people who suffer from it. This makes it necessary to investigate new alternatives for its prevention and treatment. The objective of the study was to compare the effect of Averrhoa Carambola L. (star fruit) on the skin under an animal model of hypertrophic healing. Methods: Experimental study; 10 male New Zealand breed rabbits were used, between 3 and 4 months old, with an average weight of 3 to 3.5Kg. The formation of hypertrophic scars in the ears of rabbits was induced under the model described by Morris et al. One of the groups received 1 mL of a 10% aqueous solution of the lyophilized star fruit, while the other received 1 mL of triamcinolone acetonide; in both groups the application was intralesional and weekly in a month. After the treatment, under sedation, only the hypertrophic scars were extracted using a biopsy punch and the tissues were preserved in 10% formalin for subsequent pathological examination. Results: The group that received star fruit solution significantly improved the dermis and epidermis in the hypertrophic scars on the ears of rabbits that received treatment. When compared with the group that received triamcinolone acetonide, there were no statistically significant differences. Conclusion: The lyophilized aqueous extract of star fruit at 10% demonstrated a similar effect compare to triamcinolone acetonide (treatment of choice) in reducing the fibrosis of hypertrophic scars in the ears of rabbits.

Posterior sub-tenon injection of triamcinolone in non-resolving vitreoretinitis - A case report

Purpose: To evaluate the efficacy of posterior sub-tenon injection of triamcinolone in non-resolving vitreoretinits. Introduction: Vitreoretinits is the inflammation of the vitreous and retina. In a non-resolving case of vitreoretinitis steroids are the mainstay of treatment. Steroids can be administered via various routes into the eye. Posterior subtenon injection of Triamcinolone acetonide is an effective treatment option for anatomical and functional improvement in intermediate and posterior uveitis. Methods: A 46-year-old female presented to the outpatient department with decreased vision in her left eye for 3 months. On examination, she had a BCVA of 6/60 in her left eye. Fundoscopy showed vitreous haze grade 3 due to vitritis, multiple vitreoretinal tractional bands extending along both the superior and inferior arcade, macular edema, and a retinitis patch of less than half disc diameter size just above the superior arcade. The patient was positive for IgG antibodies to Cytomegalovirus and Herpes Simplex virus. The patient was started on oral prednisolone 1mg/kgbw once a day and topical prednisolone acetate 1.0%, nepafenac 0.3%, and timolol 0.5%. The patient was given posterior subtenon injection of 0.5ml of triamcinolone acetonide 40mg/ml. Results: She had 6/12 BCVA at the end of 1 month with resolving vitritis and macular edema. By the end of 3 months, she had fully resolved vitreoretinitis with 6/6 vision. Discussion: Most steroids used in ophthalmology are glucocorticoids, which have anti-inflammatory and immunosuppressive activity. Triamcinolone Acetonide is a minimally water-soluble suspension. Triamcinolone crystals slowly dissolve into the vitreous. This creates a diffusional gradient from the vitreous to the macula with minimal systemic exposure. Our study also showed significant improvement in visual acuity and reduction in macular edema with a single posterior subtenon injection of triamcinolone acetonide. Conclusion: A subtenon injection of triamcinolone acetonide appears to be an effective treatment for decreased vision associated with intermediate and posterior uveitis without any significant side effects.

Triamcinolone Acetonide Injection and Topical as an Alternative Method for Mucocel Therapy

Introduction: Mucocele is a swelling caused by the collection of saliva from the ducts of minor salivary glands that are cut off or blocked. This is a salivary gland cyst that contains mucus and generally founded in the oral cavity. Surgery is the most popular therapy in the treatment of mucocele. There are various alternative therapeutic modalities that can be used including laser ablation, cryosurgery, sclerotherapy, micromarsupialization, laser surgery, injection of sclerosis agents, and corticosteroid injection. Case and management: This paper describes the treatment of mucoceles using triamcinolone acetonide that is quite often used in the oral cavity. The therapy carried out is intradermal injection of 0.2 ml of triamcinolone acetonide IA/ID (10 mg/ml) and topical application of triamcinolone acetonide ointment in orabase 0.1% 6x/day. One week later it was seen that the mucocele lesion had almost disappeared. Discussion: Corticosteroids act as potent anti-inflammatory agents and also act like sclerosing agents causing shrinkage of the dilated salivary ducts. Conclusion: Triamcinolone acetonide can be an alternative therapy besides surgery in the management of mucocele cases. The application can be done by intradermal injection and topical ointment. No side effects were found at the end of treatment.

Efficacy and Systemic Effects of a Single Deep Orbital Triamcinolone Injection for Thyroid Eye Disease.

Orbital steroid injections offer a potential therapeutic avenue for managing Thyroid Eye Disease (TED). This study aimed to assess the effectiveness and potential systemic impacts of a single deep orbital triamcinolone injection in TED patients. In a prospective investigation conducted from January 2021 to March 2023, patients diagnosed with TED were enrolled. Inclusion criteria encompassed a Clinical Activity Score (CAS) of ≥3, extraocular muscle inflammation, and upper eyelid retraction. A total of 1 mL of triamcinolone acetonide (40 mg/mL) was administered posterior to the orbital septum at both the medial and lateral aspects of both the upper and lower eyelids. Parameters, including CAS, margin-reflex distances (MRD1 and MRD2), intraocular pressure (IOP), ocular motility (Hess area ratio [HAR%]), exophthalmometry, extraocular muscle size, and blood and urinary indices, were evaluated before and at 2 and 4 weeks after a single injection. Analysis included 28 patients (23 women, 5 men; mean age (SD): 38.7 (11.1) years), representing 56 eyes. Following the injection at 4 weeks, the mean CAS and MRD1 significantly decreased by 2 points and 0.8 mm, respectively. There was a 4.5% increase in HAR%, and extraocular muscle size decreased by 4 to 15.3 mm². Neutrophil count, C-reactive protein, and thyroid antibodies significantly decreased. No severe adverse ophthalmic or systemic effects, including IOP increases or liver damage, were observed. Bilateral single orbital triamcinolone injections provided relief from TED symptoms through both direct effects on orbital soft tissue and systemic effects by decreasing antibody reactions.

Effects of Local Injection of Steroids in Treatment of Posttraumatic Temporalis Muscle Trismus

Trauma to the temporalis muscle sometimes associated with the trismus that may interfere with many daily activities like eating, speech and oral hygiene maintenance, so the treatment is necessary. Aims of study: were to evaluate the effects of local injection of steroids triamcinolone in and around the scar in the temporalis muscle to alleviate the trismus. Materials and methods: Thirty patients presented with trauma in Al-Salam teaching hospital to the temporal region. The procedure done by using local anesthetic agent injected by dental syringe around the scar. Then 1 ml of triamcinolone acetonide injected directly in the scar area and the injection site covered by surgical dressing. Jaw stretching exercise start immediately after injection and daily basis exercises. Two injections interval about 3 weeks repeated in the scar area. The exercise done four times daily for 10 minutes and lasting for four weeks. The improvement of mouth opening checked every five days and mean taken by measuring the inter incisal distance by a ruler. The follow up period continues for 3 months after treatment. Results: There is significant post-operative improvement of mouth opening and the range of inter incisal distance became about 2-4 cm, The patients how start treatment within first two months after trauma show significant improvement in comparison with those who start treatment after 3 months were there is a certain relapse in spite of prolong time and frequency of muscle stretching exercise. Conclusions: Post-traumatic trismus can be treated by early management of local steroid injection along with jaw stretching exercise for masticatory muscle if started in proliferating phase of wound healing.

Comparative Effectiveness of Corticosteroid Dosages for Ultrasound-Guided Glenohumeral Joint Hydrodilatation in Adhesive Capsulitis: A Randomized Controlled Trial

ObjectiveTo investigate the efficacy of hydrodilatation with 40 mg triamcinolone acetonide (TA) compared with the same procedure with 10 mg TA in patients with adhesive capsulitis (AC) of the shoulders. DesignProspective, double-blind, randomized controlled trial with 12 weeks of follow-up. SettingTertiary care rehabilitation center. ParticipantsEighty-four patients diagnosed with AC (N=84). InterventionsUltrasound guidance using (A) hydrodilatation with 4 mL of TA (40 mg)+4 mL 2% lidocaine hydrochloride+12 mL normal saline or (B) hydrodilatation with 1 mL of TA (10 mg)+4 mL 2% lidocaine hydrochloride+15 mL normal saline through the posterior glenohumeral recess. Main Outcome MeasuresShoulder Pain and Disability Index (SPADI), visual analog scale (VAS) for pain, and range of motion (ROM) at baseline and at 6 and 12 weeks after injection. ResultsBoth groups experienced improvements in the SPADI score, VAS scores for pain, and ROM throughout the study period. However, group-by-time interactions were not significant for any outcome measurement at any follow-up time point. No adverse events were reported in either group. ConclusionUltrasound-guided hydrodilatation with 40 and 10 mg TA yielded similar improvements in SPADI, VAS score, and ROM at the 12-week follow-up. Considering the potential detrimental effects of corticosteroids on the adjacent cartilage and tendons, a low dose of TA would be preferable for ultrasound-guided hydrodilatation for AC.

A Comparison of Intra-Articular Blood Cell Secretome and Blood Cell Secretome with Triamcinolone Acetonide in Dogs with Osteoarthritis: A Crossover Study.

Osteoarthritis (OA) is a growing welfare problem for dogs and a challenge to manage for the clinician, and most therapeutic options aim to control pain. In a randomized, double-blinded, placebo-controlled, 2-way, 2-period crossover study, we aimed to evaluate the use of Blood Cell Secretome (BCS) administrated intra-articularly, with or without the combination with triamcinolone, in dogs with bilateral hip OA. BCS is an acellular orthobiologic containing anti-inflammatory and anabolic proteins produced from the patient’s own blood through extended coagulation in a defined environment. Fifteen dogs were initially assigned to a BCS group (BCSG, n = 5), a triamcinolone group (TG, n = 5), or a combination group (BCS+TG, n = 5). All had bilateral hip OA. After a 180-day follow-up, the crossover was performed with BCSG (n = 7) and BCS+TG (n = 7). BCSG received a single intra-articular administration of 3 mL of Blood Cell Secretome, and BCS+TG received BCS plus 0.5 mL of triamcinolone acetonide (40 mg/mL). The volume in BCSG was corrected to 3.5 mL with saline. In all patients, both hips were treated. For treatment follow-up, a copy of the Canine Brief Pain Inventory (divided into pain interference score—PIS and Pain Severity Score—PSS), Liverpool Osteoarthritis in Dogs (LOAD), and Canine Orthopedic Index (COI, divided into function, gait, stiffness, and quality of life) was completed on days 0, 8, 15, 30, 60, 90, 120, 150, and 180. Results were analyzed with the Mann−Whitney U test, effect size, and Kaplan−Meier estimators, followed by the log-rank test. p was set at <0.05. Patients of the sample had a mean age of 9.6 ± 2.9 years and a body weight of 29.2 ± 3.9 kg. Seven hips were classified as severe osteoarthritis, and eight were classified as moderate. No differences were found between groups at T0. Significant differences were observed in PSS scores at +8d, with BCS+TG exhibiting better results. PIS, PSS, LOAD, stiffness, and function scores were also lower in BCS+TG from +15 to +60d. The two groups showed similar improvements from +90 to +120d. Kaplan−Meier estimators showed that dogs in BCS+TG showed clinically-important differences for longer, despite a positive result in BCSG. The intra-articular administration of BCS alone was able to improve the overall condition of OA patients. Its combined use with triamcinolone acetonide lead to a faster and longer-lasting improvement in pain scores.

Fibrin glue: an anti-fibrotic agent for contracted socket

Background: The contracted socket is caused by fibrosis leading to the shortening of the orbital tissue. Vascular endothelial growth factor (VEGF) is a profibrotic factor in postoperative wound healing. The novel option to prevent fibrosis is the use of fibrin glue. This study aims to evaluate the role of fibrin glue in reducing the VEGF expression in cells that cause post-socket surgery scar. Methods: An in vivo experimental study using an animal model was conducted. We used twenty eyes of white rabbit species as the study sample. The evisceration was carried out and distributed to the animals in four experimental groups consisting of the control group, the MMC group (0.1 ml of mitomycin-C (MMC) 0.4 mg/ml), the triamcinolone acetonide (TCA) group (0.1 ml of TCA 40 mg/ml), and the fibrin glue group (0,1 ml of fibrin glue). The treatment was performed through injection of the subconjunctival. After 14 days, rabbits were euthanized, and conjunctiva samples were cut. Immunoreactivity scores (IRS) were used to analyze the expression of VEGF in epithelia conjunctiva with a significant level of p &lt;0.05. Data were analyzed using SPSS version 26 for Windows. Results: All groups showed a statistically significant difference in VEGF expression with a p-value 0,000 (p&lt;0,05). The VEGF level was significantly lower in the three treatment groups compared with the control group. The VEGF expression was highest for the control group, followed by fibrin glue, TCA and MMC group. We found significant differences between the control group and the three treatment groups; the MMC group (p=0.001), the TCA group (p=0.002), and the fibrin glue group (p=0.005). While differences in VEGF expression between the three treatment groups could not be proven statistically. Conclusion: Fibrin glue is proven to reduce VEGF expression as a marker of fibrosis; thus, fibrin glue can be an alternative anti-fibrotic agent.

Effects of local intraoperative epidural use of triamcinolone acetonide-soaked Gelfoam on postoperative outcomes in patients undergoing posterolateral lumbar spinal fusion surgery: a randomized, placebo-controlled, double-blind trial.

Prior evidence has supported the use of local intraoperative epidural steroids in lumbar discectomy for improvements in postoperative pain and outcomes. However, currently there is a paucity of data regarding the efficacy of local epidural steroids in spinal fusion procedures. The present investigation aimed to evaluate the impact of local epidural administration of triamcinolone acetonide-soaked Gelfoam on postoperative pain and patient-reported outcomes in patients undergoing instrumented posterolateral lumbar spinal fusion. In this randomized, double-blind, placebo-controlled trial, patients were randomly divided into two groups (treatment and control). Patients in the treatment group received a Gelfoam carrier soaked in 1 ml of triamcinolone acetonide (40 mg), which was placed over the nerve roots in the epidural space before the closure. Patients in the control group received a Gelfoam carrier soaked in normal saline in a similar fashion to the treatment group. Patients were followed up during their hospital stay and at 4 and 12 weeks postoperatively. The primary outcome measure was early postoperative visual analog scale (VAS) scores for pain both at rest and with movement. A total of 100 patients were recruited in this study and were randomly allocated to the treatment or control group. No significant difference was found in baseline demographic, clinical, and surgical characteristics between the two groups. Postoperative VAS scores for pain both at rest and with movement were comparable between the treatment and control groups. Cumulative morphine consumption, length of hospital stay, and incidence of postoperative complications such as surgical site infection were also similar between the two groups. There was no significant difference in patient-reported outcomes including VAS scores for back and leg pain as well as the Oswestry Disability Index at 4 and 12 weeks postoperatively. The proportion of patients who achieved a minimum clinically important difference for patient-reported outcomes were also similar between the two groups. In contrast to the existing literature on the beneficial use of local intraoperative epidural steroids in conventional lumbar discectomy, the present study did not demonstrate such significant efficacy for the use of local epidural steroids in instrumented posterolateral lumbar spinal fusion. However, there is still a lack of evidence in this regard and further high-quality clinical trials are required to evaluate the efficacy of local epidural steroids in this group of patients.

S2303 Endoscopic Balloon Dilation of Recurrent Peptic Stricture in a Patient With Portal Hypertension

Introduction: Variceal hemorrhage is a devastating complication and a major cause of mortality in patients with portal hypertension. Unfortunately, one third of patients with varices develop bleeding in their lifetime. This case depicts a rarely reported intervention that physicians may be hesitant to pursue. Case Description/Methods: A 61-year-old male with history significant for atrial fibrillation (afib), alcoholic cirrhosis complicated by gastric and esophageal varices, and GERD presented with dysphagia. He previously underwent endoscopic variceal band ligation (EVL) in 2009 for primary prevention of esophageal varices and placed on daily nadolol. His GERD was controlled with twice daily PPI and as-needed H2 antagonist. Despite this, he developed strictures secondary to severe erosive esophagitis. He was then started on apixaban for afib and transitioned from nadolol to carvedilol. His MELD-Na is 8 and had a reported distant history of hepatic encephalopathy. He presented to the esophageal motility clinic with progressive dysphagia to both solids and liquids. An EGD was scheduled which revealed a partially obstructive ulcerative stricture spanning 29 - 34 cm from incisors. The stricture was injected with 4 ml of triamcinolone acetonide distributed in 1 cm increments across 4 quadrants. Then the stricture was dilated with a 10-12 mm cre balloon under fluoroscopic guidance. Dilation caused shallow mucosal tears with scant blood but otherwise no significant bleeding or complication. The scope was traversed into the stomach with retroflexion revealing moderate gastric varices in the cardia. After the procedure was completed, the patient had complete resolvent of symptoms and tolerated oral nutrition (Figure). Discussion: This case describes a cirrhotic patient with portal hypertension requiring frequent endoscopic balloon dilations for severe dysphagia secondary to recurrent peptic strictures. Extensive literature review did not reveal any documented cases describing this scenario. The presence of gastric varices in this patient is indicative of active portal hypertension. This in combination with the patient’s anticoagulation places a theoretical high risk of bleeding during the procedure. Although this case demonstrates that it is safe to perform serial dilations in patients with portal hypertension if they have undergone EVL and do not have active esophageal varices.Figure 1.: A) EGD showed ulcerative peptic stricture located in the mid-esophagus. (B) There was scant bleeding after dilation, otherwise no significant bleeding or complication. (C) Retroflexion was performed in the stomach and revealed moderate gastric varies in the cardia.

A new treatment modality for the enlarged extraocular muscles.

evaluation of the role of combined injection of triamcinolone acetonide with 5 Fluorouracil in treatment of the enlarged extraocular muscles secondary to chronic non-specific non-infectious inflammation. injection of 0.1ml of triamcinolone acetonide 40mg/ml and 0.1ml of 5 Fluorouracil 50mg/ml in the enlarged extraocular muscles secondary to chronic non-specific non-infectious inflammation in 6 patients, after the confirmation of the histopathological diagnosis of these patients by revising their medical records. There was a significant improvement in the visual acuity, in addition to a significant improvement also in the clinical and the radiological features in the patients who were consented for the trial of the new injection protocol. However, there was failure of clinical and radiological improvement in one case presented with sever fibrosis. There was a significant absence of the side effects in all patients except for one patient that reported discomfort near the inner canthus. The new protocol of the treatment is a promising modality that can be used in the chronic non-infectious inflammation without extensive fibrosis.

A first report on the efficacy of a single intra-articular administration of blood cell secretome, triamcinolone acetonide, and the combination of both in dogs with osteoarthritis

BackgroundOsteoarthritis represents a significant welfare problem for many dogs, with limited therapeutic options other than palliative pain control. To evaluate the effect of the intra-articular administration of blood cell secretome and triamcinolone, 15 dogs with bilateral hip osteoarthritis were randomly assigned to a blood cell secretome (BCSG, n = 5), triamcinolone (TG) or their combination group (BCS + TG, n = 5). BCSG received a single intra-articular administration of 3 ml of blood cell secretome, TG 0.5 ml of triamcinolone acetonide 40 mg/ml, and BCS + TG received the combined products. The volume to administrate was corrected to 3.5 ml with saline. On days 0, 8, 15, 30, 60, 90, 120, 150, and 180, a copy of the Canine Brief Pain Inventory (divided into pain interference score—PIS and Pain Severity Score—PSS), Liverpool Osteoarthritis in Dogs (LOAD), Hudson Visual Analogue Scale (HVAS), and Canine Orthopedic Index (COI, divided into function, gait, stiffness, and quality of life) was completed. Results were analyzed with the Kruskal–Wallis test and the Kaplan–Meier estimators were conducted and compared with the Log Rank test, p < 0.05.ResultsAnimals in the sample had a mean age of 9.0 ± 2.9 years and a bodyweight of 28.8 ± 4.1 kg. Hips were classified as moderate (8) and severe (7) osteoarthritis. No differences were found between groups at T0 regarding considered evaluations. Significant differences were observed between groups in pain scores from + 8d- + 150d, with BCS + TG exhibiting better results. The same was observed for HVAS and LOAD, from + 8d- + 120d. Improvements were also observed in several dimensions of the COI. Kaplan–Meier estimators showed that BCS + TG produced longer periods with better results, followed by BCSG and TG.ConclusionThe intra-articular administration of blood cell secretome improved the clinical signs and scores of several clinical metrology instruments in dogs with hip OA, particularly when combined with triamcinolone. Further studies are required.

A comparative study to assess the clinical outcomes in osteoarthritis of the knee between intra-articular platelet rich plasma (PRP) injections vs intra-articular corticosteroid injections

Osteoarthritis (OA) is by far the most common form of joint disease throughout the world. It is strongly associated with age, and extremely common in older people, Some studies estimate that over 80% of people over 55 years of age have osteoarthritis of at least one joint. It mainly affects the hips, knees, spine, hands and feet. Hip and knee OA are the most important because of the high prevalence of pain and disability that they cause in older adults. Methodology: Patients visiting the Department Of Orthopaedics, Narayan Medical College and Hospital that meet the inclusion criteria. Patient were be divided into 2 groups randomly (30 in each group).one group was administered intra- articular corticosteroid injection (1 ml of triamcinolone acetonide with 1ml of 2% lignocaine without epinephrine). And the other group was administered intra-articular prp injection into the affected knee (5 ml of prp). Following treatment they were assessed using mcmaster universities arthritis index (womac) [56 visual analogue scale (vas), scoring systems which will be recorded through questionnaires prior to the injection to record baseline scores and post injection then at 6 weeks, 3, 6 and 12months follow-up. Result: Significant difference was seen in mean WOMAC scores in Group A and Group B at 1 week, 4weeks, 8 weeks, 12 weeks and 12 months but no significant differences were observed at 6 months. Significant differences were seen in the VAS score for Group A and Group B subjects at 1 week, 4 weeks, 8 weeks, 12 weeks, 6 months and 12 months when compared using independent t test as p

Efficacy of Intravitreal Triamcinolone Acetonide in Diabetic Macular Edema

Diabetic macular edema (ME) can be treated by intravitreal injection of Triamcinolone acetonide (TA). The scope of the study was to determine its efficacy in our setup in order to develop our local guidelines for its routine use in our setup. Objective: To determine the effect of intravitreal Triamcinolone(TA) for the management of diabetic macular edema(ME) Material and Methods: This descriptive case series carried out at Al-Shifa Trust Eye Hospital, Rawalpindi in 2019. Total 149 patients cases of either gender aged 40-75 years with history of DM of &gt;10 years, VA&lt;6/36 assessed by Snellen VA chart and who had clinically significant ME as assessed by indirect ophthalmoscopy were included in the study. 4mg/0.1 ml of TA was injected through pars plana under local anesthesia. Efficacy was determined at six week post treatment. Results: Treatment was found to be effective in overall 40.9%(n=61) cases, 44.7%(n=38) males, 35.9%(n=23) were females, 35.1%(n=20) were between 41-50 years age, 42.9%(n=30) between 51-60 years, 50%(n=11) had &gt;60 years, 44.5%(n=49) at baseline VA of 6/36 and 30.8%(n=12) with baseline VA of 6/60 showed improvement in VA. Conclusion: Administration of triamcinolone acetonide(TA) intravitreal inj. is an effective modality for the treatment for diabetic macular edoema, and this treatment may lead to an improvement in visual acuity Keywords: Diabetic Retinopathy, Macular Edema(MA), Triamcinolone, Acetonide

A randomized clinical trial of triamcinolone acetonide injection for suppression of inflammation after blepharoptosis surgery

This study aimed to determine the effectiveness of triamcinolone acetonide in suppressing inflammation after blepharoptosis surgery. The study was designed as prospective, randomized, two medical centers' clinical trial. Thirty-two patients with involutional blepharoptosis of the same degree in both eyelids underwent bilateral transcutaneous levator advancement. At the end of the surgery, 4mg/0.1ml of triamcinolone acetonide was injected into a randomly selected upper eyelid. The fellow eyelid was not injected and was used as control. Facial photographs were taken on day 1, week 1, month 1, and month 3, and the degree of inflammation, the margin reflex distance 1 (MRD-1), and levator function (LF) between the two eyelids of each patient were compared. The primary outcome was the selection of the less inflamed eyelid decided by the majority of three individuals unrelated to the study. MRD-1 and LF were analyzed for secondary outcomes. As a result, the injected eyelid was judged to be the less inflamed eyelid in all cases. The MRD-1 in the postoperative period less than 1 month was significantly larger in the injected eyelids than the control eyelids (P<0.03). The postsurgical MRD-1 at month 3, the postsurgical LF at all postsurgical examination times were not statistically different. Adverse complications by the injection, including ptosis, levator dysfunction, increase of the intraocular pressure, and visual disturbance were not observed. In conclusion, a triamcinolone acetonide injection after ptosis surgery is both safe and effective in reducing the early postsurgical inflammation and helpful in an earlier return to a daily routine for the patients.

Safety and Efficacy of Suprachoroidal Injection of Triamcinolone in Treating Macular Edema Secondary to Noninfectious Uveitis.

Introduction One of the leading causes of blindness throughout the world is uveitis, which predominantly results in the feared complication of macular edema. We report the safety and efficacy of suprachoroidal injection of triamcinolone acetonide in the treatment of macular edema secondary to noninfectious uveitis. Methodology This prospective, nonrandomized interventional study was conducted at Layton Rahmatullah Benevolent Trust (LRBT) Eye Hospital, Lahore, from August 2019 till July 2020. All individuals older than 18 years, nonpregnant females with a central macular thickness of >320 µm were included. Those patients with uncontrolled diabetes, immunodeficiency, or any other disease mandating systemic corticosteroid use were excluded. All patients had a detailed ocular exam one week before the treatment, and 0.1 ml of triamcinolone acetonide 40 mg/ml was injected using a 30-G hollow needle into the suprachoroidal space. After the injection, an eye patch was applied and the patient was observed for three hours. All data were documented in a preformed proforma. ResultsA total of 30 patients were included in the study with a mean age of 38.1 ± 9.48 years. Statistically significant differences were found between central macular thickness at presentation and at one and three months of the procedure, i.e., 569.60 ± 170.396, 266.77 ± 73.127, and 208.27 ± 37.292 µm, respectively. A similar difference was observed when comparing visual acuity at baseline to visual acuity at one and three months of the procedure (p < 0.001). Conclusion The current study indicates that a single dose of suprachoroidal injection of triamcinolone acetonide for the treatment of macular edema secondary to uveitis is safe and efficacious. No rise in intraocular pressure (IOP) was observed during the study period. Significant improvements in central macular thickness and visual acuity as well as tolerability and safety of the treatment were seen in our study. Further larger-scale studies are needed to ascertain the long-term benefits of the suprachoroidal triamcinolone acetonide.

Is a Steroid Injection in Both Compartments More Effective than an Injection in the Extensor Pollicis Brevis Subcompartment Alone in Patients with de Quervain Disease? A Randomized, Controlled Trial.

Ultrasonography (US)-guided steroid injections can improve the accuracy of injection in patients with de Quervain disease, especially in those with an intracompartmental septum. Although the main lesion of de Quervain disease in patients with a septum is a stenosing tenosynovitis of the extensor pollicis brevis (EPB), no report we know of has compared injection into the EPB subcompartment with an injection into both the abductor pollicis longus (APL) and EPB subcompartments. In this randomized trial, we compared the results of US-guided steroid injections targeting both subcompartments and the EPB subcompartment alone in patients with de Quervain disease. (1) Do patients who receive a steroid injection in the EPB subcompartment alone have lower pain scores at 6 weeks and at 3 months after US-guided injection compared with patients who receive an injection in both subcompartments? (2) Do patients who receive a steroid injection in the EPB subcompartment alone experience fewer steroid injection-related complications than patients who receive an injection in both subcompartments? A randomized controlled study was performed at a single center between August 2018 and March 2021. Patients with a diagnosis of de Quervain disease and with a complete intracompartmental septum between the APL and the EPB tendons were included. In total, 112 patients had a diagnosis of de Quervain disease during the study period. Definite, complete subcompartmentalization was seen in 50 patients. Patients were randomly assigned to US-guided injections targeting both subcompartments (n = 25) or the EPB subcompartment alone (n = 25). There were no between-group differences in age, gender, affected wrist, or disease duration, and all patients had US evidence of tendinosis of the EPB, with or without tendinosis of the APL. Although 33% of patients (16 of 48) showed tendinosis of the APL, no patient showed tendinosis of the APL alone. In all patients, a dorsal-to-palmar side injection of 0.5 mL of 2% lidocaine and 0.5 mL of triamcinolone acetonide (40 mg/mL) was administered by two experienced hand surgeons. In the both-subcompartments group, US-guided injections were performed in each of the APL and EPB subcompartments. In the EPB subcompartment group, US-guided injections were administered in the EPB subcompartment only. All patients underwent the same protocol after the procedure. Four percent (n = 2, 1 in each group) of patients were excluded after randomization because their pain level was not registered. Pre- and postinjection clinical outcome assessments were completed by orthopaedic surgery residents not involved in patient management. Patients were regularly examined at baseline, 6 weeks, and 3 months to evaluate the intensity of pain. We assessed pain by the VAS score, where 0 indicated no pain and 100 the most pain. At baseline, the VAS score was 67 ± 14 in the both-subcompartment group and 67 ± 16 in the EPB subcompartment group (mean difference 0.17 [95% CI -8.45 to 8.82]; p = 0.97). Complications related to the steroid injection, including numbness, tendon rupture, and skin hypopigmentation, were also recorded at final follow-up examinations. To determine statistical power, the VAS score for pain at 6 weeks after the injection was used as the primary outcome variable. The minimum clinically important difference for the VAS score was deemed to be 20 mm, and we estimated an SD of 23. A sample size calculation indicated that a sample of 21 patients per group would provide 80% power to detect an effect of this size between the groups at the p = 0.05 level using a t-test. There were no differences in the VAS scores between the both-subcompartment group and the EPB group at 6 weeks (10 ± 6 versus 10 ± 7, mean difference -0.08 [95% CI -4.08 to 3.91]; p = 0.97). The same was true at 12 weeks (12 ± 13 versus 11 ± 15, mean difference 0.38 [95% CI -7.74 to 8.49]; p = 0.09). No adverse events related to treatment (such as tendon rupture, infections, and numbness) occurred in either group. However, skin hypopigmentation occurred at the final follow-up examination in both groups. The proportion of patients experiencing skin hypopigmentation in the EPB subcompartment group was lower than in the both-subcompartment group (33% [8 of 24] versus 67% [16 of 24]; odds ratio 0.25 [95% CI 0.08 to 0.83]; p = 0.02). Our data suggest that a US-guided steroid injection targeting the EPB subcompartment alone is as effective in terms of pain reduction as targeting both subcompartments in patients with de Quervain disease who have complete septation. Furthermore, an injection targeting the EPB subcompartment alone can reduce the dose of steroids used, perhaps thereby decreasing complications related to steroid injections. We recommend using only single-compartment injections in this context, even among patients with an intracompartmental septum. Level I, therapeutic study.

Ultrasound-Guided Triamcinolone Acetonide Hydrodissection for Carpal Tunnel Syndrome: A Randomized Controlled Trial.

Background: Despite the wide use of corticosteroid hydrodissection for carpal tunnel syndrome (CTS), there is insufficient evidence to confirm its efficacy. This study aimed to compare the effectiveness of corticosteroid hydrodissection vs. corticosteroid perineural injection alone on clinical and electrophysiological parameters in patients with CTS.Method: This prospective randomized controlled trial (RCT) was conducted in a tertiary care center with a follow-up period of 12 weeks. Subjects were randomly assigned to either ultrasound-guided hydrodissection with a mixture of 1 mL of triamcinolone acetonide (10 mg/mL), 1 mL of 2% lidocaine, and 8 mL normal saline or ultrasound-guided perineural injection with 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of 2% lidocaine. The primary outcome measure was the symptom severity subscale (SSS) of Boston Carpal Tunnel Questionnaire (BCTQ) scores at baseline and at 6 and 12 weeks' post-treatment. The secondary outcomes included the functional status subscale (FSS) of BCTQ and the distal motor latency and sensory nerve conduction velocity of the median nerve. The effect of interventions on the designated outcome was analyzed using a 3 × 2 repeated measures analysis of variance. The within-subject and among-subject factors were differences in time (before the intervention, and 6 and 12 weeks after injection) and intervention types (with or without hydrodissection), respectively.Results: Sixty-four patients diagnosed with CTS were enrolled. Both groups experienced improvement in the SSS and FSS of BCTQ and median nerve distal motor latency and sensory nerve conduction velocity. However, group-by-time interactions were not significant in any outcome measurements. No serious adverse events were reported in either group, except for two patients in the hydrodissection group who reported minor post-injection pain on the first day after the intervention, which resolved spontaneously without the need for additional treatments.Conclusion: Hydrodissection did not provide an additional benefit compared to corticosteroid perineural injection alone. More prospective studies are needed to investigate the long-term effectiveness of corticosteroid hydrodissection, as well as its influence on median nerve mobility.

Ultrasound-Guided Hydrodilatation With Triamcinolone Acetonide for Adhesive Capsulitis: A Randomized Controlled Trial Comparing the Posterior Glenohumeral Recess and the Rotator Cuff Interval Approaches.

For patients with adhesive capsulitis, hydrodilatation is typically performed using corticosteroids with ultrasound guidance via the posterior glenohumeral recess. Recently, a new intervention technique via the rotator cuff interval has been described. This study aimed to compare the efficacy of hydrodilatation with triamcinolone acetonide via the posterior glenohumeral recess and the rotator cuff interval in patients with adhesive capsulitis. This prospective randomized controlled trial was conducted in a tertiary care center with a follow-up period of 12 weeks. We enrolled 64 patients diagnosed with shoulder adhesive capsulitis. The subjects were randomly assigned to two groups that received hydrodilatation with corticosteroids either through the posterior glenohumeral recess or though the rotator cuff interval. The injection contained 4 ml of triamcinolone acetonide (40 mg) mixed with 4 ml of 2% lidocaine hydrochloride and 12 ml of normal saline. The shoulder pain and disability index, visual analog scale for pain, and range of motion were analyzed before and at 6 and 12 weeks after the treatment. Both groups experienced improvements in the visual analog scale scores, shoulder pain and disability index scores, and range of motion throughout the study period. A significant group-time interaction was observed in terms of the visual analog scale for pain during motion (p = 0.019), favoring hydrodilatation through the rotator cuff interval. Thus, hydrodilatation through the rotator cuff interval might be a better treatment option than that through the posterior glenohumeral recess for patients with adhesive capsulitis, considering its superior effect in alleviating pain during shoulder movement.