Subtenon Triamcinolone Injection Research Articles

Cystoid Macular Edema from Cancer-Associated Retinopathy

This article reviews the diagnosis and management of a patient with cancer-associated retinopathy (CAR) secondary to small cell lung cancer who developed a rare presentation of CAR, cystoid macular edema (CME). CAR is a rare cause of unexplained, often rapid, visual acuity and visual field loss. A 67-year-old man with a recent history of photopsias and simultaneous dimming of vision presented to our clinic. Four months before, he had been diagnosed with small cell lung cancer. Retinal examination was normal, but the visual field was severely constricted. He was referred for an electroretinogram and an evaluation by a retina specialist because of a strong suspicion of CAR, which was confirmed. Despite a lack of strong clinical evidence for the treatment of CAR, and no clinical recommendations for CME found in CAR, our patient's CME was initially treated with diclofenac QID and, subsequently, a sub-tenon injection of triamcinolone. Since his diagnosis of CME, he has been chronically managed with diclofenac QID to treat his edema, with relatively stable visual acuity. His visual fields remain highly constricted. CAR is a rare form of painless bilateral vision loss in patients with a history of cancer. Our patient developed CME from his CAR, and was treated with diclofenac and sub-tenon injections of triamcinolone. Despite potential options for treatment, none have demonstrated much efficacy, and the visual prognosis is typically poor.

Werner syndrome with refractory cystoid macular edema and immunohistochemical analysis of WRN proteins in human retinas

BackgroundTo present our findings in a case of Werner syndrome with refractory cystoid macular edema (CME) and to determine the expression and the distribution of WRN proteins in human retinas.Case presentationA 35-year-old man with Werner syndrome who developed CME after YAG laser treatment was studied. Optical coherence tomographic (OCT) scans were used to examine the CME in the right eye. The patient received topical eye drops (0.1% bromfenac sodium hydrate twice daily and 1% dorzolamide hydrochloride thrice daily), sub-Tenon triamcinolone injection thrice, intravitreal bevacizumab injection twice, and pars plana vitrectomy of the right eye. Genetic analyses were performed to diagnose the disease. To examine the expression and distribution of WRN proteins in the retinas, immunohistochemistry for WRN proteins was performed in human retinas. The CME in the right eye was not improved by any of the treatments. During the follow-up period, CME developed in the left eye. Genetic analyses detected compound heterozygosity, Mut4 and Mut11, in the WRN gene and the individual was diagnosed with Werner syndrome. Immunohistochemical analysis of WRN proteins expression in human retinas showed that WRN proteins were expressed in the parts of the Müller cells in the inner nuclear layer and outer nuclear layer.ConclusionPatients with Werner syndrome can develop severe CME after laser treatment. A pathological link may exist between mutations in the WRN gene and the development of CME in patients with Werner syndrome.

Bilateral Panuveitis in a Patient on Vemurafenib BRAF Inhibitor Therapy for Stage IV Melanoma

To describe a case of recurrent, bilateral panuveitis caused by the BRAF proto-oncogene inhibitor vemurafenib. Case report. A 25-year-old woman developed bilateral panuveitis and macular edema after initiating treatment with the BRAF enzyme inhibitor vemurafenib for stage IV cutaneous melanoma. The patient was successfully treated with sub-Tenon triamcinolone injections along with cessation of the medication. Panuveitis is a potential adverse effect of vemurafenib. Good communication with oncology is necessary, in case the medication needs to be discontinued.

Intravitreal versus subtenon injection of triamcinolone acetonide for diabetic macular edema

ObjectiveThe aim of this study was to compare the results of intravitreal injection with subtenon injection of triamcinolone in diabetic macular edema (DME).BackgroundTriamcinolone injection for DME.Patents and methodsThe study is a prospective randomized clinical trial including 80 eyes of patients with DME. Patients were divided into two groups: group I and group II. Group I (73.1% men and 26.9% women; mean age 55.7 ± 7.2 years) included 40 eyes that received 4 mg of intravitreal triamcinolone acetonide injection. Group II (65.5% men and 34.5% women; mean age 55.8 ± 7.9 years) comprised 40 eyes that received 40 mg of subtenon triamcinolone acetonide injection. The patients were followed up after 1 week and 1, 3, and 6 months later to assess best-corrected visual acuity, intraocular pressure, and macular thickness. Fluorescein angiography and optical coherence tomography were used to evaluate the improvement.ResultsThere was a statistically significant difference between the studied groups at 1 week and 1 month (P < 0.05) and no significant difference at 3 and 6 months (P > 0.05) as regards their post-treatment outcome for visual acuity, and there was no statistically significant difference between the studied groups at 1 and 6 months (P > 0.05) as regards their post-treatment outcome for macular thickness.ConclusionBoth intravitreal and subtenon triamcinolone injections cause a significant increase in visual acuity; the effect is early and more pronounced in the intravitreal group but subtenon injection is safer.

Pars plana vitrectomy combined with focal endolaser photocoagulation for idiopathic macular telangiectasia.

Background. To report the outcome of pars plana vitrectomy (PPV) combined with intraoperative endolaser focal photocoagulation (PC) on eyes with idiopathic macular telangiectasis (MacTel) type 1. Methods. This was a retrospective study of two female patients with MacTel type 1 who were resistant to focal photocoagulation, sub-Tenon triamcinolone injection, and/or antiangiogenic drugs. The best-corrected visual acuity (BCVA) was determined, and fluorescein angiography (FA) and spectral domain optical coherence tomography (SD-OCT) were performed before and after surgery for up to 19 months. Results. After surgery, the BCVA gradually improved from 20/100 to 20/20 at 19 months in Case 1 and from 20/50 to 20/13 at 13 months in Case 2. Fluorescein angiography (FA) showed leakage at the late phase, and OCT showed that the cystoid macular edema was resolved and the fovea was considerably thinner postoperatively. Conclusion. Patients with MacTel type 1 who are refractory to the other types of treatments can benefit from PPV combined with intraoperative endolaser focal PC with functional and morphological improvements.

Efusión uveal asociada a gammapatía monoclonal de significado indeterminado tipo IgM lambda

Case reportA 68-year-old man was referred to the hospital with progressive decreased vision in the right eye over the past year. A moderate cataract and annular choroidal thickening were found. The diagnosis of uveal effusion was confirmed by ultrasound and fluorescein and indocyanine green angiography. Laboratory studies showed an IgM lambda subtype monoclonal gammopathy of undetermined significance. The patient underwent cataract surgery, and a sub-Tenon's triamcinolone injection with a satisfactory short-term outcome. ConclusionThis association has not been previously reported, and it shows that IgM lambda subtype monoclonal gammopathy of undetermined significance should be added to the list of disorders associated with uveal effusion.

Fingolimod-Associated Macular Edema: Resolution by Sub-Tenon Injection of Triamcinolone With Continued Fingolimod Use

Fingolimod-Associated Macular Edema: Resolution by Sub-Tenon Injection of Triamcinolone With Continued Fingolimod Use

Therapeutic dilemma in serpiginous choroiditis

A 43-year-old woman had blurred vision in the left eye for 4 years. Her best-corrected visual acuity was 20/20 in the right eye and 20/200 in the left eye. The fundus showed grayish-yellow, jigsaw-puzzle-shaped lesions at the level of the retinal pigment epithelium and choriocapillaries emanating from the optic nerve head in both eyes. Fluorescein angiography showed late leakage in active lesions and hypofluorescence in hyperpigmented areas. Oral prednisolone and cyclosporine were given first. However, after posterior subtenon triamcinolone injections in both eyes and one intravitreal triamcinolone injection in the left eye, macular edema worsened. Steroid-induced central serous chorioretinopathy was suspected, so we tapered prednisolone rapidly and changed to azathioprine. Subsequent optical coherence tomography demonstrated retinal pigment epithelial detachment in the right eye subsided gradually. Fundus autofluorescence imaging showed progressively quiescent lesions. Unfortunately, acute myocardial infarction, atrial fibrillation, and ischemic stroke developed after 6 weeks azathioprine. In the acute phase of serpiginous choroiditis, corticosteroids are most commonly used. However, steroid therapy may be complicated with steroid-induced central serous chorioretinopathy. When we shift to other systemic immunosuppressive regimens, such as azathioprine, the possibility of acute myocardial infarction should be kept in mind.

Subtenon triamcinolone injection for postoperative cystoid macular edema associated with tafluprost

PurposeWe report the successful treatment of a case of cystoid macular edema (CME) associated with topical tafluprost, which was accompanied by serous retinal detachment (SRD).CaseA 78-year-old woman underwent intraocular lens suture surgery, including anterior vitreous cutting, for crystalline lens dislocation in the right eye. Tafluprost was initiated 12 weeks after surgery. Intraocular pressure (IOP) was controlled at 10–14 mmHg. Visual acuity remained at 20/40–30/40. However, the patient complained of blurred vision (20/200) 9 months after surgery. CME accompanied by SRD was identified by optical coherence tomography (OCT) and treated with subtenon triamcinolone injection. Visual acuity rapidly increased to 20/50, and the volume of SRD decreased in a few days. Discontinuation of tafluprost and initiation of diclofenac eye drops improved visual acuity to 20/40 and resulted in improved OCT findings within a few weeks. Three months after injection, tafluprost was resumed along with diclofenac. No recurrence of CME occurred over the following 3 months, and IOP was controlled at 10–15 mmHg.ConclusionSRD is considered to be a symptom of treatment-resistant CME, which may lead to poor visual acuity after recovery. In such cases, subtenon triamcinolone injection should be strongly considered at an early stage.

Choroidal infarction after photodynamic therapy combined with bevacizumab and triamcinolone reversed by tissue plasminogen activator: case report.

To present a case of choroidal infarction after combined therapy of photodynamic therapy, intravitreal bevacizumab, and sub-Tenon triamcinolone injection salvaged by tissue plasminogen activator administration. Interventional case report. Combined therapy of full-fluence photodynamic therapy, intravitreal bevacizumab, and sub-Tenon triamcinolone injection was given on the same day to treat neovascular age-related macular degeneration in an 82-year-old patient. Subsequent acute visual loss and marked macular edema as a result of choroidal infarction were noted. Intravitreal and sub-Tenon administration of tissue plasminogen activator were performed 9 days later to salvage the choroidal infarction, and visual improvement was noted. Fundoscopy and optical coherent tomography showed almost complete resolution of macular edema. Indocyanine green angiography revealed reperfusion of the choroidal vessels. Choroidal infarction may happen after combined therapy. Tissue plasminogen activator administration may reverse the infarction and help visual recovery.

Migration of intravitreal dexamethasone implant to anterior chamber.

To describe two cases of migration of intravitreally injected dexamethasone implant into the anterior chamber. Charts were reviewed of two patients who received sustained-release dexamethasone implant intravitreally for chronic intractable cystoid macular edema. Both patients had pseudophakic cystoid macular edema and a complicated clinical course before receiving the implant. Treatments before intravitreal injection of implant included topical nonsteroidal anti-inflammatory drugs, sub-Tenon triamcinolone injections, vitrectomy, and, in one case, intravitreal bevacizumab. Both patients responded well to triamcinolone injections but required repeated injections. This led to the decision to inject the implant. Within 2 weeks of injection, the implant was noted in the anterior chamber causing pain and decreased vision from corneal edema. Both patients underwent successful removal of the implant. Sustained-release intravitreal injectable implants can migrate freely in vitrectomized pseudophakic or aphakic eyes. Selection of a scleral-fixated steroid implant might be safer in such cases.

SECTOR LASER PHOTOCOAGULATION FOR THE PREVENTION OF MACULAR EDEMA AFTER PLAQUE RADIOTHERAPY FOR UVEAL MELANOMA

To investigate the role of sector laser photocoagulation for prevention of macular edema after plaque radiotherapy for uveal melanoma. Noncomparative, pilot interventional case series. The main outcome measure was optical coherence tomography-evident macular edema. A total of 29 patients had sector laser photocoagulation (sector panretinal photocoagulation) and sub-Tenon triamcinolone injection. The median tumor thickness and base was 3.3 mm and 10.0 mm. The median radiation dose and rate to the macula was 2,944 cGy and 31.0 cGy/hour. At the 12-month and 24-months follow-up, cystoid macular edema was found in 17% and 24% of the sector panretinal photocoagulation group. There were no major side effects registered. Sector panretinal photocoagulation in combination with sub-Tenon triamcinolone appears to show potential as a safe and beneficial intervention for the prevention of macular edema after plaque radiotherapy for uveal melanoma in this series.

The evaluation of efficacy of subtenon triamcinolone injection combined with focal laser photocoagulation in diabetic macular edema

Amac: Bu calismanin amaci subtenon triamsinolon (ST) enjeksiyonu ile fokal lazer fotokoagulasyon kombinasyonunun diyabetik makuler odem (DMO)\'de etkinlik ve guvenilirliginin arastirilmasidir. Gerec ve yontem: Diyabetik makuler odem olan ve fokal lazer fotokoagulasyon ile birlikte 40 mg ST enjeksiyonu yapilan hastalarin dosyalari retrospektif olarak degerlendirildi. On yedi hastanin 17 gozu calisma kapsamina alindi. Tum hastalara tedavi oncesi tam bir oftalmolojik muayene yapildi. Tedavi sonrasi 1. hafta, 1. ay ve daha sonra 3 aylik donemlerde kontrole cagrildi. Tedavinin etkinligi ST enjeksiyonundan sonraki 1. ay ve ardindan 3 aylik donemlerde gorme keskinligi ve floresein anjiyografi (FA) ile degerlendirildi. Istatistik analizde tekrarli olcumlerde ANOVA testi kullanildi. Bulgular: Hastalarin yas ortalamasi 61,5±8,7 yil idi. Gorme keskinligi enjeksiyon oncesi 0.22±0.13 iken 1. ayda 0.39±0.15, 3. ayda 0.36±0.18, 6. ayda 0.33±0.15 ve 12. ayda 0.34±0.16 oldu. Tum takip muayenelerindeki ortalama gorme keskinlikleri enjeksiyon oncesi ile karsilastirildiginda aradaki fark anlamli idi (p ˂0.05). Son muayenede gorme keskinligi 13 (%76,4) hastada artti, 3\'unde (%17,6) ayni kaldi ve 1\'inde (%5,8) azaldi. Sonuc: Diyabetik makuler odemi olan hastalarin tedavisinde subtenon 40 mg triamsinolon enjeksiyonu ile fokal lazer fotokoagulasyon kombinasyonunun guvenli ve yararli oldugu dusunuldu.

Eyelid cutaneous hypopigmentation after sub-tenon triamcinolone injection after retinal detachment repair.

Cutaneous hypopigmentation has been reported after steroid injection. Sub-Tenon triamcinolone injection is often administered to control or prevent ocular inflammation. Observational case report. Lower eyelid cutaneous hypopigmentation developed 6 weeks after sub-Tenon triamcinolone injection administered at the conclusion of scleral buckle and vitrectomy for retinal detachment repair. The hypopigmentation eventually resolved at 7 months postoperatively. Sub-Tenon triamcinolone injection at the conclusion of retinal surgery can cause temporary cutaneous hypopigmentation of the eyelid. This risk should be explained preoperatively to patients, particularly those who are more heavily pigmented.

Successful treatment of prostaglandin-induced cystoid macular edema with subtenon triamcinolone

PurposeCystoid macular edema (CME) is associated with the use of prostaglandin eye drops after cataract surgery. The study aim was to report on the treatment of two CME patients with subtenon triamcinolone injections.MethodsCase one was a 70-year-old woman who underwent uneventful cataract surgery. Travoprost was administrated at 10 weeks after surgery, and CME occurred at 13 weeks after surgery. Case two was an 85-year-old man who underwent intraocular lens extraction and an intraocular lens suture operation. Latanoprost was readministered after the surgery. The patient complained of blurred vision 3 years later.ResultsFor both cases, discontinuation of the prostaglandin eye drops, subsequent initiation of treatment with diclofenac eye drops, and subtenon injection of triamcinolone was followed by the rapid disappearance of the CME. After the CME had disappeared for 3 months, the prostaglandin eye drops were resumed. Diclofenac was added in case two. No CME recurrence was seen in either case over 2 years.ConclusionSubtenon triamcinolone injection can be effective for CME associated with prostaglandin eye liquid after cataract surgery. Prostaglandin eye liquid that causes CME is not necessarily precluded for future use if administered under careful observation.

Combined Therapy of Intravitreal Bevacizumab and Posterior Subtenon Triamcinolone Injection in Macular Edema with Branch Retinal Vein Occlusion

Combined Therapy of Intravitreal Bevacizumab and Posterior Subtenon Triamcinolone Injection in Macular Edema with Branch Retinal Vein Occlusion

Traitement des décollements de l’épithélium pigmentaire par photothérapie dynamique, IVT de ranibizumab, sous-ténonienne de triamcinolone

To investigate the effect of a triple therapy associating subtenon triamcinolone acetonide, intravitreous ranibizumab and photodynamic therapy for treatment of retinal pigment epithelium detachment (RPED) complicating occult choroidal neovascularization in age-related macular degeneration. PATIENTS-METHOD: A prospective clinical trial including 27 patients showing retinal pigment epithelium detachment. We treated these patients with intravitreous ranibizumab injections and subtenon triamcinolone injections as well as a single session of photodynamic therapy at 48 h. At least two more intravitreous ranibizumab injections were added at 1-month intervals. Initial visual acuity was 1.3/10 at 9 months, which was minimal follow-up. Twenty-three patients had total resumption of retinal pigment epithelium detachment on optical coherence tomography imaging after 1 month. One patient had ocular hypertension and needed trabeculectomy, one had a pigment epithelium break but with good functional results. Seven patients needed six intravitreous injections of ranibizumab with partial or total resumption in six cases. RPED is a severe complication of choroidal neovascularization in age-related macular degeneration. Untreated, it means a rapid loss of macular function. Often damage is bilateral. Simple intravitreous injection of ranibizumab is not satisfying. An association of photodynamic therapy and intravitreous triamcinolone injections shows good results. We propose a triple treatment for the best possible synergy. Our preliminary results are encouraging. Since we did not want to inject a large volume of Triamcinolone into the vitreous, we chose subtenon injections. Treatment of retinal pigment epithelium detachment is difficult. Associating intravitreous injection of ranibizumab, dynamic phototherapy, and subtenon triamcinolone provides good results.

Intravitreal ranibizumab for choroidal neovascularization secondary to acute multifocal posterior placoid pigment epitheliopathy

Intravitreal ranibizumab for choroidal neovascularization secondary to acute multifocal posterior placoid pigment epitheliopathy

Steroid eye drop treatment (difluprednate ophthalmic emulsion) is effective in reducing refractory diabetic macular edema

To evaluate the efficacy of treatment of refractory diabetic macular edema (DME) after vitrectomy with difluprednate ophthalmic emulsion 0.05% (Durezol(TM)), and to compare this treatment with sub-Tenon's injection of triamcinolone (STTA). This study enrolled patients with refractory diabetic macular edema that persisted despite pars plana vitrectomy in our clinic. In all subjects, more than 3 months had passed since prior treatment. Eleven eyes in ten subjects were treated with STTA (STTA group), and 11 eyes in seven subjects were treated with difluprednate ophthalmic emulsion 0.05% (Durezol(TM), Sirion Therapeutics Inc., USA) 4 times daily for the first month and then twice daily for 2 months (eye drop group). In the eye drop group, mean VA (+/- SD) was 0.67 +/- 0.35 logMAR and mean retinal thickness was 500.6 +/- 207.7 mum at baseline. After 3 months of treatment, mean VA was 0.67 +/- 0.29 and mean retinal thickness had decreased to 341.2 +/- 194.8 mum. The mean minimum value of RT during the treatment period was 300.6 +/- 123.2 mum, and significantly lower than that at baseline (Mann-Whitney U test: P = 0.003). In the STTA group, mean VA (+/- SD) was 0.67 +/- 0.35 logMAR, and mean retinal thickness was 543.3 +/- 132.6 mum at baseline. After 3 months of treatment, mean VA was 0.49 +/- 0.67, and mean retinal thickness had decreased to 378.6 +/- 135 mum. The mean minimum value of RT during the treatment period was 349.9 +/- 113.8 mum, and significantly lower than at baseline (Mann-Whitney U test: P = 0.003). The rate of effective improvement in RT did not differ between the eye drop group (73%) and STTA group (84%) (Fisher's exact test: P = 1). Comparable improvements of retinal thickness were observed in the STTA and eye drop groups. Instillation of difluprednate ophthalmic emulsion 0.05% is a safe and effective treatment that does not require surgical intervention and does not produce severe side-effects.

Coroidite serpiginosa macular: relato de caso

Serpiginous choroiditis is a rare ocular inflammatory disease that can lead to permanent vision loss due to macular involvement. This article reports a case of a patient with macular serpiginous choroiditis submitted to subtenon and intravitreal triamcinolone injections. The clinical aspects and differential diagnosis of this ocular disease, including fluorescein angiogram and high-resolution optical coherence tomography are discussed.