Subtenon Triamcinolone Acetonide Research Articles

Severe Circulatory Disturbance in Optic Disc, Retina, and Choroid Following Sub-Tenon Triamcinolone Acetonide Injection for Posterior Scleritis.

To report a rare case of optic disc and chorioretinal vascular occlusions in the right eye following sub-Tenon injection of triamcinolone acetonide (STTA) in an older male patient with scleritis and to discuss the associated risk factors and potential alternative therapies. The medical history and clinical examination, including fundoscopy, fluorescein angiography (FA), and indocyanine green angiography (ICGA), were conducted to diagnose and evaluate the extent of vascular occlusion after STTA. An extensive literature review was undertaken to ascertain the associated risks and consider other treatment options for scleritis. Severe circulatory disturbances in the optic disc and chorioretinal regions of the right eye developed after STTA for exacerbated scleritis, as confirmed by FA and ICGA, resulting in a significant decrease in visual acuity. A complex medical history encompassing ophthalmic and systemic health issues may have contributed to this negative outcome. A literature review pointed out the potential complications of STTA and highlighted alternative approaches to scleritis management. Cautious application of STTA in treating scleritis is crucial, especially in patients with pre-existing vascular or ocular conditions. Thus, a multidisciplinary approach and a careful assessment of various treatment options are vital to minimize the risk of severe complications and improve patient outcomes.

Successful management of exudative retinal detachment in retinopathy of prematurity with sub-Tenon triamcinolone acetonide ınjection following laser photocoagulation: A case report

In this case report, we describe the successful treatment of exudative retinal detachment after laser photocoagulation with sub-Tenon’s injection of triamcinolone acetonide in a premature infant with retinopathy of prematurity (ROP). A preterm infant born at 25 weeks gestation and of weight 860 g was diagnosed with zone 2 stage 3 ROP with plus disease. Laser photocoagulation was performed to treat the active disease. After laser treatment, the infant developed exudative retinal detachment. To address the exudative retinal detachment, a sub-Tenon triamcinolone acetonide injection was administered. The procedure was well tolerated, and the patient showed rapid improvement in both clinical and imaging findings.

Switching to subtenon triamcinolone acetonide does not jeopardize the functional and anatomic outcomes of dexamethasone implant treated eyes with diabetic macular edema.

Intraocular dexamethasone implant (DEXi) is an efficient treatment for diabetic macular edema (DME). However, it may be unavailable or contraindicated. Triamcinolone acetonide is another corticosteroid that has proved to be safe and effective in treating macular edema complicating various diseases including diabetes. The purpose of this study is to evaluate the outcomes of a switch from DEXi to subtenon triamcinolone acetonide (STTA) and back, in eyes with DME. Retrospective study. DME eyes that had been treated with DEXi and switched to STTA between October 2018 and February 2019 (stock shortage of DEXi) were included. The functional and anatomical outcomes of the switch and switch-back were studied. 26 eyes of 17 patients (mean age 67.1 ± 8.2years) were considered. The mean baseline visual acuity (VA) was 0.35 ± 0.17 decimals remaining stable after DEXi, STTA and switch-back to DEXi. The mean central macular thickness (CMT) was 492.7 ± 32.8µm initially, decreasing to 294.3 ± 133.4µm after DEXi, 369.9 ± 182.3µm after STTA and 297.6 ± 72.0µm after switching back to DEXi (all p < 0.05 versus baseline). Compared to baseline, the CMT reduction was numerically better after DEXi and switching back to DEXi than after STTA (mean reduction: -200.4µm, -167.7µm, and -95.08µm respectively, p = 0.13). Intraocular pressure was comparable after DEXi and STTA. DEXi is the steroid of choice in DME. However, STTA can be a cost-effective alternative when DEXi is unavailable or contraindicated. This study suggests that STTA may be used in the context of a step therapy in DME.

Suprachoroidal triamcinolone versus posterior subtenon triamcinolone either alone or formulated in the management of diabetic macular edema

PurposeThis study aims to compare posterior subtenon triamcinolone acetonide injection either formulated or alone versus suprachoroidal triamcinolone in the management of diabetic macular edema.MethodsThis study is a prospective interventional study that included 75 patients, divided into three groups, each group with 25 patients. Group I received a combination of triamcinolone acetonide (TA) (40 mg) and VISCOAT, which is a combination of sodium chondroitin sulfate (20 mg) and sodium hyaluronate (15 mg). The injection was done in the posterior subtenon space using the NAGATA cannula. Group II received TA (40 mg) in the posterior subtenon space. Group III underwent an injection of 4 mg/100µl of TA in the supra choroidal space.ResultsWe found a statistically significant difference between the three studied groups regarding BCVA (P = 0.001) and CMT at six months postoperative (P = 0.001) with the highest median BCVA and lowest median CMT observed in the formulated TA group.ConclusionWe concluded that early treatment of DME by formulated TA is better than TA alone, and suprachoroidal TA in the form of increasing the BCVA and decreasing the CMT without any elevation of IOP.Trial registration number NCT05464953.Date of registration 17/7/2022 (retrospectively registered).

Outcomes of Pars Plana Vitrectomy with Panretinal Photocoagulation for Treatment of Proliferative Diabetic Retinopathy Without Retinal Detachment: A Seven-Year Retrospective Study.

To review clinical outcomes of patients with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) who underwent pars plana vitrectomy (PPV) with endolaser panretinal photocoagulation (PRP) without retinal detachment (RD) repair. Retrospective chart review of the rate of postoperative clinical findings and visual acuity in patients with PDR from May 2014 to August 2021. Pars plana vitrectomy with endolaser PRP was performed in 81 eyes of 81 patients (mean age of 62.1 ± 10.5 years). At a median follow-up of 18 months, mean Snellen best-corrected visual acuity (BCVA) significantly improved from 20/774 preoperatively to 20/53 at last follow-up (P < 0.001). Postoperative complications and clinical findings included VH (12.3%), diabetic macular edema (DME) (12.3%), ocular hypertension (8.6%), RD (4.9%), and need for additional PPV (6.2%). Eyes with PRP performed within 6 months before surgery had a lower frequency of developing postoperative VH (5.3%) compared to eyes that received PRP more than 6 months before surgery (27.3%, P = 0.04). Eyes that received preoperative anti-vascular endothelial growth factor (VEGF) treatment (2.0%) had a lower frequency of postoperative VH compared to eyes that did not receive anti-VEGF treatment (14.3%, P = 0.04). Eyes that received intraoperative sub-tenon triamcinolone acetonide developed postoperative DME (4.0%) less frequently than eyes that did not receive sub-tenon triamcinolone acetonide (26.7%, P = 0.04). In patients with PDR and VH, PPV with PRP yielded significant improvements in visual acuity and resulted in overall low rates of recurrent postoperative VH. Preoperative anti-VEGF and PRP laser treatment were associated with lower rates of postoperative VH. Furthermore, intraoperative use of sub-tenon triamcinolone acetonide was associated with a lower rate of postoperative DME. Pars plana vitrectomy with endolaser PRP in conjunction with the aforementioned pre- and intraoperative therapies is an effective treatment for patients with PDR and VH.

Posterior sub-Tenon triamcinolone acetonide injection for annular choroidal detachment resistant to systemic immunosuppressive treatment.

Posterior sub-Tenon triamcinolone acetonide injection for annular choroidal detachment resistant to systemic immunosuppressive treatment.

Comparison between intravitreal ranibizumab injection and posterior subtenon triamcinolone acetonide injection at time of cataract surgery for prevention of progression of diabetic macular edema

BackgroundThe goal of this work is to assess progression of diabetic macular edema (DME) following intravitreal ranibizumab injection compared to subtenon triamcinolone acetonide injection at cataract operation.MethodsRetrospective analysis of 73 eyes of 65 participant with DME, with central macular thickness (CMT) ≥ 300 μm. The included eyes were separated into three groups; phacoemulsification with intravitreal Ranibizumab injection group, phacoemulsification with subtenon Triamcinolone acetonide injection group and phacoemulsification only group. Main measures involved best corrected visual acuity (BCVA) one week, one month and three months post-operative. The CMT was compared preoperative and postoperative (one and three months).ResultsAfter 1 month of operation, there was a statistical substantial distinction in the median of CMT between ranibizumab & control group (p < 0.001), between subtenon TA & control group (p < 0.001) and in ranibizumab and subtenon TA group (p = 0.023). After 3 months, the variance between ranibizumab & control group was considerable (p < 0.0001) and the variance between subtenon TA & control group was considerable (p = 0.030).ConclusionsCombined phacoemulsification with intravitreal injections of ranibizumab or subtenon triamcinolone acetonide may prevent further progression in CMT in individuals with DME following cataract operation.

Efficacy of topical dexamethasone eye drops in preventing ocular inflammation and cystoid macular edema following uncomplicated cataract surgery with or without injection of a single dose perioperative subtenon triamcinolone acetonide

Purpose To evaluate the efficacy and safety of topical dexamethasone (DEX) eye drops in combination with a single perioperative subtenon triamcinolone acetonide (sTA) injection versus conventional topical DEX eye drops in the prevention of ocular inflammation and cystoid macular edema following cataract surgery. Materials and methods Medical records of 245 eyes of 245 patients who underwent uncomplicated cataract surgery were analyzed in this retrospective controlled clinical study. Topical DEX eye drops were administered to 128 eyes routinely postoperatively, and 117 eyes were given a single dose of sTA (40 mg/ml) together with topical DEX eye drops for postoperative care. Postoperative topical antibiotic prophylaxis was applied to all eyes. The primary outcomes were anterior chamber (AC) cells and flare, central macular thickness (CMT), best corrected visual acuity (BCVA), and intraocular pressure (IOP) measurements on day 7, day 30, day 90, and day 180 following surgery. Results Although CMT increased in the DEX group, no increment was observed in the DEX + sTA treated group for all follow-up periods (on day 7 (+1.3 ± 18.6 and −8.7 ± 21.9 μm, p = 0.038), on day 30 (+20.5 ± 58.4 and −4.1 ± 25.2 μm, p = 0.009), on day 90 (+7.2 ± 19.9 and −5.7 ± 30.6 μm, p = 0.029), and on day 180 (+8.2 ± 22.6 and −6.4 ± 32.9 μm, p = 0.032)). There was no significant difference in terms of AC cells and flare between the two groups during the entire follow-up period (p > 0.05). Significant improvement in BCVA was observed in the DEX + sTA group at day 30 (p = 0.008). IOP differences were comparable, and both groups had high ocular tolerance. There were no severe adverse effects recorded. Conclusions Topical DEX eye drops in combination with single dose perioperative injection of sTA have robust efficacy in preventing ocular inflammation and the development of cystoid macular edema following uncomplicated cataract surgery.

Posterior subtenon triamcinolone acetonide combined with phacoemulsification for patients with diabetic maculopathy

Posterior subtenon triamcinolone acetonide combined with phacoemulsification for patients with diabetic maculopathy

Effect of Posterior Subtenon Triamcinolone Acetonide in Refractory Diabetic Macular Edema

Objectives: To see the effect of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection in refractory Diabetic Macular Edema (DME).&#x0D; Study Design: Quasi-Experimental Study.&#x0D; Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi, from Jun to Dec 2018.Methodology: Patients with Clinically Significant Macular Edema (CSME), with Central Macular Thickness (CMT) &gt;300 microns and those who did not respond to three consecutive Intra-Vitreal Bevacizumab (IVB) injections were included. Posterior Subtenon Triamcinolone Acetonide (PSTT) was administered by a single retina fellow using the same protocol. Each patient’s best-corrected visual acuity (BCVA), Intra-ocular pressure (IOP) and Central Macular Thickness (CMT) were evaluated on the day of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection and again at 1, 3 and 6 months.&#x0D; Results: Out of 52 patients (104 eyes), 16 females and 36 males were present. The mean age was 57.67±9.35 years. Out of 52 right eyes, the mean Central Macular Thickness (CMT) at the first visit was 388.83±172.04 µm, 332.81 ± 144.69 µm after one month, 292.81±147.59µm after six months of Posterior Subtenon Triamcinolone Acetonide (PSTT) Injection. Similarly, for 52 left eyes mean Central Macular Thickness (CMT) at the first visit is 375.79±160.81 µm, 364.52 ± 167.95 µm after one month and 323.37±155.74 µm after six months. Similar results were observed for IOP and BCVA.&#x0D; Conclusion: Posterior Subtenon Triamcinolone (PSTT) injections are effective in diabetic macular oedema, which does not respond to intravitreal anti-VEGF (IVB) therapy.

Posterior subtenon triamcinolone acetonide combined with phacoemulsification for patients with diabetic maculopathy

Posterior subtenon triamcinolone acetonide combined with phacoemulsification for patients with diabetic maculopathy

Intravitrealversus Posterior Subtenon Triamcinolone Acetonide in Conjunction with Intravitreal Bevacizumab for Refractory Diabetic Macular Edema

Purpose &#x0D; Aim of this study was to evaluate and compare the effects of combined simultaneous injection of intravitreal triamcinolone acetonide and bevacizumab versus intravitreal bevacizumab and posterior subtenon triamcinolone acetonide in treatment of persistent refractory diabetic macular edema after intravitreal bevacizumab injection failure&#x0D; Methods&#x0D; 40 pseudophakic diabetic patients were enrolled in quasi experimental study conducted at ophthalmology department. All eyes were specifically diagnosed with persistent refractory diabetic macular edema with central retinal thickness of _____on OCT. Patients were divided into two groups. Group A was given simultaneous injection of intravitreal bevacizumab 1.25mg/0.05ml with posterior subtenon triamcinolone 40mg and group B was given intravitreal bevacizumab in conjunction with simultaneous intravitreal triamcinolone 2mg/0.05 ml.Patients were followed upmonthly till three months. Changes in the best corrected visual acuity, intraocular pressure and central retinal thickness by optical coherence tomography were evaluated in both groups. Retreatment was given at 12 weeks interval whenever indicated by OCT.&#x0D; Results &#x0D; Group B showed a more significant decrease in the median CRT at 1month (p =0.0002)but after 3 months both groups showed a reduction in CRT which was not statistically significant between two groups _____. Both groups had significant improvement in BCVA compared to pre-injection baseline visual acuity.Between two groups BCVA changes were not statistically significant at 3 months _____.Five eyes in group B developed IOP beyond 22mmHg, which was treated with anti glaucoma medications within 2 weeks. No eye in group A developed IOP greater than 21mmHg. At 12 weeks, 7 of group A patients and 6 of group B patients developed recurrent macular edema and required repeated injections.&#x0D; Conclusion&#x0D; While treating persistent refractory diabetic macular edema, posterior subtenon triamcinolone is as effective as intravitreal triamcinolone in conjunction with intravitreal bevacizumab in reducing CRT and improving and stabilizing BCVA but in terms of IOP rise posterior subtenon injection is safer as compared to intravitreal injection. Both treatments are cost effective and combined simultaneous injections decrease the number of repeated injections.

Subtenon triamcinolone injection to treat serous choroidal detachment after glaucoma surgery: A case series.

To report the effect of subtenon triamcinolone acetonide (TA) injection in the treatment of serous choroidal detachment (SCD) after glaucoma surgery. In this prospective case series, patients with persistent, non-resolving, or progressive SCD after glaucoma surgery were enrolled. For those with non-resolving or progressive SCD despite of using systemic corticosteroids, topical atropine and topical steroids, one milliliter of TA (40mg/mL) was injected inferotemporally into the posterior subtenon space. Sixteen consecutive patients with a mean ± SD age of 70.12 ± 11.12 years were included in this study. After injection of subtenon TA, SCD was completely resolved after 1 to 4 weeks, with deepening of the anterior chamber in all cases. All cases were followed for at least 6 months after the injection with no signs of recurrence. Subtenon injection of TA is a safe and effective modality of treatment for resolving a persistent or progressive SCD after glaucoma surgeries.

Subtenon triamcinolone as an adjuvant in mitomycin-C-enhanced trabeculectomy in non-inflammatory glaucomas: A randomized clinical trial.

This unicentric randomized clinical trial was designed to compare the surgical outcomes of mitomycin C-enhanced trabeculectomy (MMC-TRAB) with and without subtenon triamcinolone acetonide (TAAC) injection in patients with non-inflammatory glaucomas. This trial is registered at the Brazilian Registry of Clinical Trials (ReBEC) under the register number RBR-53f8nh. Consecutive non-inflammatory glaucoma patients requiring surgical intervention were randomized into two groups. In the control group, eyes underwent standard MMC-TRAB, while in the intervention group, besides the standard MMC-TRAB, these eyes also received a subtenon TAAC injection (4mg) close to the bleb site at the end of the surgery. The main outcomes of the study were surgical success rates, intraocular pressure (IOP) and number of medications at all timepoints. Success was defined as IOP ≤ 15 mmHg and subdivided in complete or qualified according to the need of medication. A total of 75 eyes of 63 different patients were included (intervention group = 39 eyes; control group = 36 eyes). There was no difference between groups at baseline (p>0.11). Multivariable regression analysis indicated that IOP levels were significantly lower in the intervention group at 18 and 24 months of follow-up when number of medications was considered as a covariate (P<0.001). Complete success rates were higher in the intervention group at 06 (90.9% vs 68.7%; p = 0.03), 12 (87.2% vs 66.7%; p = 0.02) and 18 months (87.2% vs 66.7%; p = 0.02). Additionally, although success rates at 24 months were higher in the intervention group (82.0% vs 66.7%; p = 0.09), this difference did not reach statistical significance. Qualified success rates did not significantly differ between groups at all timepoints. In conclusion, this study found significantly lower IOPs levels at 18 and 24 months of follow-up and higher complete success rates until 18 months of follow-up, with the use of subtenon TAAC as an adjuvant to standard MMC-TRABs in non-inflammatory glaucoma patients.

Synergistic Effect of Combined Sub-Tenon Triamcinolone and Intravitreal Anti-VEGF Therapy for Uveitic Macular Edema.

PurposeTo investigate effects of intravitreal anti-VEGF in combination therapy with sub-Tenon triamcinolone acetonide (STA) injection for uveitic macular edema (UME).DesignA single-center, retrospective cohort study.MethodsThe medical records were obtained for 65 eyes of 65 patients with UME. Of which, 32 eyes received combined anti-VEGF with STA injection, and 33 eyes received 40 mg of STA injection alone. The primary outcome was the reduction of central macular thickness (CMT) measured with optical coherence tomography (OCT). Resolution rate of clinical UME and changes of best corrected visual acuity (BCVA) over 24 weeks were secondary outcomes.ResultsThere was a significantly greater reduction of CMT with the combination treatment than with STA alone at 1-week (β = −157.9, P < 0.001) and 1-month (β = −53.1, P = 0.019) after injection. The cumulative incidence of macular edema resolution of all eyes was 87.7%, with 90.6% (29/32) in the combined group and 84.8% (28/33) in the STA group, respectively. More incidence of UME resolution was observed in the combined group than the STA group after 1 week (71.9% vs 15.2%, P < 0.001) and 4 weeks (84.4% vs 54.5%, P = 0.009), respectively. BCVA was better for the combination treatment than STA alone at 1-week (β = −0.085, P = 0.070) and 1-month (β = −0.108, P = 0.019) after injection, respectively. Increased intraocular pressure (>25 mmHg) was observed in 4 eyes (12.5%) in the combined group and 5 eyes (15.2%) in the STA group, respectively.ConclusionCombined intravitreal anti-VEGF and STA is superior to STA alone for reduction of UME and visual restoration. Addition of anti-VEGF did not increase risk for steroid-induced elevation of intraocular pressure over 6 months.

Choroidal Structural Changes of Posterior Subtenon Triamcinolone Acetonide Injection in Eyes with Refractory Diabetic Macular Edema.

Purpose To access the choroidal structural changes of posterior subtenon triamcinolone acetonide (PSTA) injection in eyes with refractory diabetic macular edema (DME). Methods Patients with refractory DME were enrolled and followed for 4 weeks after switching to PSTA injection. All patients underwent spectral-domain optical coherence tomography with enhanced depth imaging, and the choroidal images were binarized into the luminal area and total choroidal area. Subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) were evaluated before and after switching treatments. Results After switching to PSTA treatment, the final best-corrected visual acuity and central subfield thickness in eyes with refractory DME were significantly improved compared to the baseline values (P=0.002 and P < 0.001, respectively). Both the SFCT and CVI decreased during the follow-up period, and significant decreases were observed at 4-week follow-up (P < 0.001 and P=0.012, respectively). The linear regression analysis showed a significant correlation between the baseline SFCT and the final visual outcomes (P=0.047). Conclusions The alterations of SFCT and CVI in this study suggest that the choroidal vasculature is involved in the pathogenesis of refractory DME and could be affected by PSTA treatment. SFCT rather than CVI may be a prognostic biomarker for eyes with refractory DME.

Subtenon Triamcinolone Acetonide Injection with Topical Anesthesia in Pediatric Non-Infectious Uveitis.

IntroductionSubtenon triamcinolone acetonide (Kenalog®; Bristol Myers Squibb) (STA) injections are commonly used in the treatment of adults in an outpatient setting. However, publications on detailing its outpatient use, safety, and efficacy in the pediatric population are scarce.MethodsWe reviewed STA injections performed in children in the outpatient clinics at two tertiary centers from 2014 to 2020. All children were aged ≤ 18 years and had a diagnosis of non-infectious uveitis. STA injections were done using 0.5 cc (20 mg) triamcinolone injected superotemporally with only topical anesthesia. Data on the efficacy and safety of STA in treating inflammation and compiled data on visual acuity improvement and incidence of ocular complications were evaluated.ResultsForty-eight eyes in 30 patients were included. The mean age of patients was 13.1 (range 7–18) years. There were no immediate complications observed in all injections performed. At the 3-month follow-up, inflammation had improved in 85.4% of eyes, macular edema had resolved in 77.8% of eyes, and there was significant vision improvement after STA. At 6 months after STA, the incidence of ocular hypertension was 12.5% and no new cataracts had developed.ConclusionSTA injection with topical anesthesia was a well-tolerated, reasonable alternative for short-term treatment of uveitis among this pediatric population.

Intraocular Pressure Elevation After Posterior Subtenon Triamcinolone Acetonide Injection in Pediatric Non-Infectious Uveitis.

The objectives of the study were to evaluate non-infectious pediatric uveitis patients developing elevated intraocular pressure (IOP) and glaucoma following posterior subtenon triamcinolone acetonide (PSTA) injection. The data of 26 pediatric (<18 years) patients with active uveitis were retrospectively evaluated. Exclusion criteria were patients with a previous IOP >21 mmHg and previous subtenon or intraocular steroid injection. The IOP values of the patients before and after the PSTA injection and the treatments administered were recorded. PSTA injection was used in a total of 40 eyes. The mean IOP was 14.0±2.3 (12-19) mmHg before PSTA. The IOP was elevated (≥21 mmHg) in 19 eyes (48%) after PSTA with a mean IOP of 32.9±11.7 mmHg (22-55). The mean interval time to IOP elevation was 3.3±1.9 weeks (1-8). The IOP was controlled in 15 eyes (79%) with topical anti-glaucomatous and these patients were considered as having transient IOP elevation. Trabeculectomy with mitomycin C was required in 4 eyes (21%) in whom the IOP could not be controlled despite the use of maximum topical medication and oral acetazolamide at a mean duration of 9.7±3.6 months (4-19). Subtenon deposit excision was performed in 2 eyes (11%). The mean IOP at the last follow-up was 16.0±2.4 mmHg (12-20). In our study, an IOP elevation rate as high as 47% was found in pediatric non-infectious uveitis patients following only a single PSTA injection. Steroid-induced IOP elevation and resistant glaucoma can develop even after the first PSTA administration in pediatric uveitis. Filtration surgery and the excision of subtenon triamcinolone deposits, when present, are important in glaucoma management. The risk/benefit ratio must be carefully considered when administering steroid injections to children with uveitis.

Combined therapy with intravitreal aflibercept and subtenon corticosteroids in eyes with severe diabetic papillopathy: two case reports

BackgroundDiabetic papillopathy is a rare diagnosis of exclusion characterized by unilateral or bilateral optic disc edema with variable degrees of visual loss. Although the visual prognosis has been generally reported as favorable, the presence of severe disc edema associated with macular edema prompts the need for treatment. We present a specific and unreported therapeutic approach consisting of intravitreal aflibercept and subtenon triamcinolone acetonide injections in two patients with evidence of diabetic papillopathy and macular edema.Case presentationIn the first case, a 60-year-old Caucasian woman affected by type II diabetes mellitus presented with fundoscopic evidence of sequential bilateral optic disc edema associated with acute severe visual loss in both eyes. The second patient, a diabetic 57-year-old Caucasian male, presented with sudden painless visual loss in his left eye. Multimodal imaging and systemic findings correlated towards an infrequent diagnosis of diabetic papillopathy. In a period of 5–7 weeks after treatment, both patients experienced almost full visual and anatomical recovery. A steady situation was observed at 12 months of follow-up.ConclusionsBoth our cases displayed a severe grade of optic disc edema, which was optimally reversed with intravitreal aflibercept and subtenon triamcinolone acetonide leading to a relatively rapid and safe improvement in visual acuity.

Macular dual retinitis with Herpes simplex and Cytomegalovirus following periocular corticosteroid in a patient of Pemphigus Vulgaris.

Cytomegalovirus (CMV) retinitis may occur in non-HIV individuals following systemic immunosuppressive treatment or periocular corticosteroid administration. However, simultaneous multiple viral retinitis is rare in HIV-negative individuals. We report a case of dual viral retinitis in a non-HIV female on systemic immunosuppressive for pemphigus vulgaris who was administered a periocular corticosteroid injection. A 32-year-old female on double immunosuppressive therapy (prednisolone and cyclophosphamide) for pemphigus vulgaris, presented with gradual painless diminution of vision in the right eye for one month. She was initially diagnosed to have possible autoimmune neuroretinitis by the referring ophthalmologist and received a single injection of posterior subtenon triamcinolone acetonide for the same. Her vision however deteriorated further and she received an intravitreal ganciclovir injection with a revised diagnosis of CMV retinitis. Due to suboptimal response she was referred to us. Aqueous Polymerase chain reaction (PCR) revealed dual positivity for CMV and Herpes simplex virus. She was successfully managed with intravitreal ganciclovir injections, systemic acyclovir and tapering of systemic immunosuppressive drugs. The retinitis lesions resolved gradually leaving behind a pale optic disc and foveal atrophy at 12 weeks follow-up. Infective etiology must be ruled out in immunosuppressed patients before considering periocular corticosteroids. Dual viral involvement, although rare, may cause fulminant retinitis in predisposed individuals. High index of suspicion and PCR from ocular fluids should be performed at the earliest in patients with atypical or poorly responding retinitis lesions.