sub-Tenon's Capsule Triamcinolone Research Articles

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

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

Sub-Tenon's capsule triamcinolone acetonide injection to prevent brolucizumab-associated intraocular inflammation.

To investigate the efficacy of sub-Tenon's capsule triamcinolone acetonide (STTA) injections for preventing development of intraocular inflammation (IOI) related to intravitreal injection (IVI) of brolucizumab for neovascular age-related macular degeneration (nAMD). Consecutive patients with nAMD treated with brolucizumab IVIs were studied retrospectively. All eyes treated with brolucizumab in the clinic were switched from another anti-vascular endothelial growth factor agent. After the fourth case of IOI related to brolucizumab IVI, all eyes treated with brolucizumab received a STTA injection. The patients were divided into two groups: brolucizumab alone and brolucizumab combined with a STTA injection. Forty-four eyes (44 patients) treated with at least one brolucizumab IVI were studied: 14 eyes received brolucizumab IVI alone and 30 eyes received the combination therapy. IOI related to brolucizumab IVIs developed in four (28.6%) of 14 eyes in the brolucizumab group; IOI was severe in one eye, moderate in two eyes, and mild in one eye according to the HAWK and HARRIER trial definition; IOI did not develop in the 30 eyes that received combination therapy, the difference of which reached significance (p = 0.012). Regarding combination therapy, the intraocular pressure in three (10%) eyes increased to 22 to about 26mmHg after the STTA injection and returned to normal range within 2months without medication; no cataracts developed during this short mean follow-up period follow-up period of 7.1 ± 0.4months. The results indicated the possible preventative effect of a STTA injection on development of brolucizumab-associated IOI.

Comparison of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection versus topical steroids for treatment of postcataract surgery inflammation in children.

BACKGROUND:The aim of this study is to compare the clinical efficacy of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection with postoperative topical steroids in controlling intraocular inflammation in uncomplicated pediatric cataract surgery.MATERIALS AND METHODS:A prospective comparative study of children (<13 years of age) undergoing cataract surgery in a tertiary care eye center in South India. Preoperative evaluation was similar in both groups. The surgical procedure was the same for both groups except at the end of surgery only Group 1 (right eye of bilateral cataracts and all unilateral cataracts) received intraoperative 0.5 ml (40 mg/ml) posterior sub-Tenon's injection of triamcinolone acetonide. Postoperatively, Group 1 was administered only topical antibiotic and Group 2 was put on topical antibiotic, mydriatic, and steroids. Intraocular inflammation and intraocular pressure (IOP) were assessed clinically on day 1, 1st week, 1st month, and 3 months, postoperatively.RESULTS:A total of 30 eyes were included in the study. Age ranged between 1 month and 132 months, with 18 eyes included in Group 1 and 12 eyes in Group 2. The mean postoperative IOP at the 3 months follow-up was not significantly different between groups (P = 0.4). The presence of intraocular lens had no role in postoperative inflammation (P = 1). Group 2 showed more anterior segment inflammation with six eyes (50%) developing posterior synechiae and distortion of the pupil 3 months postoperatively.CONCLUSION:In pediatric cataracts, a single intraoperative sub-Tenon's capsule injection of triamcinolone acetonide appears to be safe and effective in controlling postcataract surgery inflammation.

Posterior subtenon infusion of triamcinolone acetonide as adjunctive treatment to panretinal photocoagulation using pattern scan laser for diabetic retinopathy

To estimate the effect of sub-Tenon's capsule triamcinolone acetonide injection (STTA) combined with panretinal photocoagulation (PRP) using pattern scan laser (PSL) for high risk non-proliferative diabetic retinopathy (NPDR), in terms of the inflammation and the progression of diabetic macular edema (DME). Retrospective comparative analysis. NPDR patients who underwent PRP using PSL with (STTA+PSL group, n=24) or without (PSL group, n=19) pretreatment of STTA were enrolled. We measured anterior flare intensity (AFI) and central retinal thickness (CRT) at day of STTA (day 0), and at 1, 3, 7, 11 and 15 weeks. The CRT of the STTA+PSL group was significantly lower than that of the PSL group at 7 (308.15±69.16μm versus 340.21±77.91μm, p = 0.04), 11 (283.8±60.75μm versus 335.7±67.70μm, p = 0.01) and 15 weeks (281.13±35.29μm versus 316.58±54.89μm, p = 0.02). AFI levels in the STTA+PSL group were significantly lower than those in the PSL group at 11 (10.47±3.40 versus 15.85±8.38, p = 0.007) and 15 weeks (11.38±3.31 versus 14.37±3.85, p = 0.009). The significant improvement in CRT from baseline was noticed through the observational periods in STTA+PSL group, but not in the PSL group. Pretreatment of STTA has the potential to not only prevent the worsening of DME, but also reduce the CRT and AFI of eyes with NPDR after PRP using PSL.

Effects of sub-Tenon's capsule triamcinolone acetonide injection combined with microaneurysm photocoagulation on diabetic macular edema.

PurposeTo compare the effects of sub-Tenon’s capsule triamcinolone acetonide (STTA) injection to that of STTA injection combined with microaneurysm photocoagulation (MAPC; STTA + MAPC) on eyes with diabetic macular edema (DME).Patients and methodsThe medical records of 138 eyes of 138 patients with DME treated by either STTA or STTA + MAPC were reviewed. The degree of DME was determined by the optical coherence tomographic features: patients with serous retinal detachment (SRD+; 38 eyes) and patients without SRD (non-SRD; 100 eyes). The central macular thickness (CMT) and the best-corrected visual acuity (BCVA) were measured periodically for 6 months after the treatments.ResultsThe BCVA was significantly improved in the non-SRD group after STTA + MAPC. The CMT was significantly improved in all groups and improved considerably more in the non-SRD group than in the SRD+ group after STTA + MAPC.ConclusionOur findings indicate that MAPC has an additive effect in the non-SRD type.

Effects of personalized clinical therapy for polypoidal choroidal vasculopathy

Objective To observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV).Methods Eighty-six eyes of 79 patients with PCV were enrolled in this study.There were 60 males (65 eyes) and 19 females (21 eyes).The average age was (64.48±13.15) years old.Best corrected visual acuity (BCVA),slit lamp ophthalmoscopy,fundus photography,optical coherence tomography (OCT),fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured.The average BCVA was 0.19 ± 0..20.There were three groups in this study including photodynamic therapy (PDT) group (group A,45 eyes),PDT and intravitreal ranibizumab injection group (group B,31 eyes),and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C,10 eyes).Follow up begun at 1 month after the treatment.40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months.9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months.Patients with recurrent or worsen lesions were followed by FFA or ICGA.Pre-and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed.Results All eyes (100.0 ％) in group A,20 eyes (64.52％) in group B and 9 eyes (90.00％) in group C received treatment only once.The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061,3.262,3.258; P＜0.05),but no significant difference was found between the 3 groups (t=1.345,0.683,0.168; P＞0.05).Compared to pre-treatment measures,the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239,4.334; P＜0.05),but not changed in group C (t=2.286,P＞0.05) at 1 month after treatment.Thirteen eyes in group A were followed by FFA and (or) ICGA,which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED),4 eyes with partial closed PCV,3 eyes with stable PCV and 3 eyes with worsen PCV.Ten eyes in group B were followed by FFA and (or) ICGA,which showed that there were 3 eyes with complete closed PCV,3 eyes with partial closed PCV,4 eyes with recurrence PCV.Five eyes in group C were followed by FFA and (or) ICGA,which showed that there were 4 eyes with complete closed PCV,1 eyes with recurrence PCV.Conclusion All 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree. Key words: Choroid diseases/therapy; Photochemotherapy; Antibodies, monoclonal; Triamcinolone acetonide

Comparison of Combination Posterior Sub-Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema

PurposeTo compare the efficacy of posterior sub-Tenon's capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME).Materials and MethodsForty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured.ResultsThe ETDRS scores at baseline were 25.2 ± 13.6 (mean ± SD) letters in the PSTI + MP group, whereas 21.7 ± 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 ± 15.9, 34.7 ± 16.6 and 30.9 ± 19.0 letters in the PSTI + MP group whereas by 30.9 ± 15.4, 30.1 ± 17.9 and 31.5 ± 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p < 0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 ± 148.3, 309.1 ± 131.3, 319.3 ± 93.3, 340.4 ± 123.5 µm (mean ± SD) in the PSTI + MP group vs. 369.1 ± 123.1, 241.4 ± 52.3, 277.5 ± 137.4, 290.2 ± 127.9 µm in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the PSTI + MP group, and at both 1 month (p < 0.001) and 3 months (p = 0.016) for the IVTA group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student's t-test). In contrast to the PSTI + MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group.ConclusionPSTI + MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.

Posterior Sub–Tenon’s Capsule Triamcinolone Injection Combined with Focal Laser Photocoagulation for Diabetic Macular Edema

To investigate the efficacy of posterior sub-Tenon's capsule triamcinolone injection (PSTI) combined with focal laser (FL) photocoagulation in treatment of diffuse clinically significant diabetic macular edema (CSME). Prospective randomized clinical study. Sixty patients with diffuse CSME. We randomized the patients who had CSME into 2 treatment groups. A total of 30 eyes received macular focal and grid laser photocoagulation (MP), and the second group of 30 eyes received FL photocoagulation combined with PSTI (FL + PSTI). Clinical and visual evaluations were performed at baseline and 12 and 18 weeks after treatment, and the results were compared by statistical methods. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) scores and clinical changes in macular edema. Before treatment, mean ETDRS VA scores were 45.9+/-12.7 (mean +/- standard deviation [SD]; range, 24-66) in MP (focal + grid laser) and 44.5+/-12.6 (range, 22-66) in the FL + PSTI group. Early Treatment Diabetic Retinopathy Study scores at 18 weeks were 46.4+/-14.2 (range, 20-70) after MP and 52.5+/-17.5 (range, 22-82) after FL + PSTI. Early Treatment Diabetic Retinopathy Study scores significantly improved in eyes that received FL + PSTI (P = 0.0001, paired t test). The FL + PSTI group had an increase of 12.4+/-7.1 (range, 5-26) ETDRS letters, and the MP group had an increase of 7.8+/-3.1 (range, 5-15) letters (P = 0.04, unpaired t test). Twelve of 30 (40%) cases in the MP group and 24 of 30 (80%) cases in the FL + PSTI group showed clinical improvement in macular edema according to the stereoscopic evaluation of fundus and fluorescein angiography (P = 0.003). Posterior sub-Tenon's capsule application of triamcinolone may improve early visual outcome in diffuse diabetic macular edema when combined with FL photocoagulation.