Injection Of Triamcinolone Acetonide 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

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

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

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

Pollybeak deformity in rhinoplasty: prevention and treatment.

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

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

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

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

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

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

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

Sterile endophthalmitis after intravitreal injection of triamcinolone acetonide: case report and literature review.

Objectives: The first purpose is to present the diagnosis and therapeutic approach in a patient with sterile endophthalmitis associated with triamcinolone acetonide injection. The secondary objective is to assess the incidence of this complication and to summarize the risk factors described in the literature. Case presentation: A 76-year-old male patient presented for painless, unilateral, decreased visual acuity, four days after cataract surgery and simultaneously intravitreal triamcinolone acetonide injection for diabetic macular edema in the right eye. The diagnosis of sterile endophthalmitis was made. Eight days after the presentation, the symptoms subsided, the maximum corrected visual acuity reaching that before the procedures. Discussions: The incidence of sterile endophthalmitis varies in the literature between 0% and 23.8%. Visual prognosis is good, although the pathogenesis is not fully understood. Preservatives in injectable solutions have been suggested, however, there are studies in which inflammation was also present with preservative-free products. The particle size of triamcinolone was analyzed, demonstrating an association between smaller particles and an increased frequency of adverse reactions of this type. History of uveitis, posterior capsule rupture following cataract surgery, and Irvine-Gass syndrome are other associations described. Conclusion: The physiopathological mechanism of sterile endophthalmitis is not fully understood. However, the visual prognosis is good, the final vision being dependent on the underlying pathology.

Evaluation of clinical outcomes of raised intraocular pressure following intravitreal triamcinolone acetonide injection.

Aim: To assess the incidence, risk factors, and treatment outcomes in intravitreal triamcinolone acetonide injection (IVTA) induced intraocular pressure rise and to compare IOP rise in 1-mg and 2-mg IVTA. Materials and methods: Prospective observational study conducted in all eyes receiving IVTA. Any pre-existing glaucoma and patients who received IVTA or dexamethasone implant in the last 6 months were excluded. Results: 9 between 61-70 years of age developed an IOP spike. The mean and standard deviation of age in years was 61.95 ± 8.70. Maximum eyes had ME due to Diabetic Retinopathy (53.3%). All cases of uveitic ME were reported to have an IOP spike. 2 out of 3 high myopic eyes and 1 eye with thyroid abnormality had an IOP spike. High IOP was found in 13 eyes, with more than 25 mm Hg rise in 4 eyes and more than 5 mm Hg rise from baseline IOP in 9 eyes. The mean and standard deviation of time taken for IOP raise (in days) was 46.39 ± 37.68. A total of 38 eyes received 1 mg of IVTA and the rest 22 received 2 mg of IVTA. 23.7% of 1 mg eyes experienced an IOP rise while it was 18.2% in eyes with 2 mg IVTA. The injection was repeated in 12 eyes and 41.7% developed an IOP spike among them. The independent "t" test results showed that there was a significant difference in the mean of IOP (Pre-injection) concerning the IOP rise (P=0.007*). 1 eye had IVTA crystals in the anterior chamber with raised IOP of 30 mm Hg. 1 out of 13 eyes with raised IOP needed 2 AGMs, the other 12 eyes responded well to 1 AGM. Discussion: IVTA is widely used in refractory cases of ME and steroid-induced glaucoma is the most common side effect of IVTA. To the best of our knowledge, there is a lack of literature on prospective studies on IVTA-associated risk factors, patterns of IOP elevation, and treatment outcomes. The pre-injection mean ± SD baseline IOP for uneventful eyes was 12.87±2.65 and the pre-injection mean IOP for eyes with IOP event was 15.23±2.89 (P=0.007*). Conclusion: We proposed that TA is an independent risk factor for post-intravitreal injection IOP spike. IVTA causes a maximum IOP spike at 1 to 2 months and has a protracted course that responds to anti-glaucoma medications. High baseline IOP, a repeated dose of IVTA, the presence of TA crystals in the anterior chamber, and high myopia were associated with significant IOP elevation. Abbreviations: ACD = Anterior chamber depth, AS = Anterior segment, AGM = Anti-glaucoma medications, ARMD = Age-related macular degeneration, BCVA = Best-corrected visual acuity, BRVO = Branch retinal vein occlusion, CCT = Central corneal thickness, CRVO = Central retinal vein occlusion, CME = Cystoid macular edema, CNVM = Choroidal neovascularization membrane, CSME = Clinically significant macular edema, DR = Diabetic retinopathy, ERM = Epiretinal membrane, IOP = Intraocular pressure, IGS = Irvine-Grass syndrome, GAGs = Glycosaminoglycans, IVTA = Intravitreal triamcinolone acetonide injection, ME = Macular edema, NVG = Neovascular glaucoma, OHT = Ocular hypertension, PDS = Pigment dispersion syndrome, PACG = Primary closed angle glaucoma, POAG = Primary open-angle glaucoma, PXF = Pseudoexfoliation, VA = Visual acuity, VEGF = Vascular endothelial growth factors, VH = Vonherick's grading, SD = Standard deviation, TA = Triamcinolone acetonide, TIGR = Trabecular meshwork inducible glucocorticoid response.

Effectiveness of Triamcinolone Acetonide Injection for the Treatment of Non-infectious Intermediate and Posterior Uveitis

Effectiveness of Triamcinolone Acetonide Injection for the Treatment of Non-infectious Intermediate and Posterior Uveitis

Layered dissolving microneedle containing a three-drug combination on the treatment of hypertrophic scar

Hypertrophic scars (HS), mainly caused by burns, trauma, and surgery, are associated with erythema, bumps, itching, and pain. The oral administration of Asiaticoside (AS) is a prevalent treatment for HS in clinical settings; however, its effectiveness is constrained due to its low bioavailability, necessitating high dosages for therapeutic impact. To mitigate this issue, we developed a layered dissolving microneedle (DMN) incorporating AS–ginsenoside Rb1–L–carnosine (A–G–C) at the tip for HS treatment. The tip layer of the DMNs comprised sodium carboxymethyl cellulose (CMC), while the base layer consisted of low-viscosity CMC to enhance mechanical strength. We examined its puncture performance, in vitro dissolution ability, and therapeutic effect on a rabbit ear model of HS. Histological analysis was performed by Hematoxylin and Eosin (H&E), Masson staining and Sirius red staining. The results demonstrated that the DMNs exhibited excellent puncture performance and dissolution rates. A-G-C DMNs were found to be effective in reducing scar thickness by measuring scar thickness changes. Histological analysis revealed that the A–G–C DMNs significantly reduced inflammation and collagen fiber deposition in scar tissue. Importantly, the therapeutic effect achieved with A–G–C DMNs was comparable to that of triamcinolone acetonide injection. These findings highlight the potential of DMNs loaded with A–G–C as a promising treatment modality for HS, offering improved bioavailability and therapeutic outcomes.

Efficacy and Safety of Triamcinolone Acetonide Injections Following Rhinoplasty: A Systematic Review of Recommended Doses, Complications, and Outcomes.

Triamcinolone acetonide injections (TAIs) have been suggested to decrease complications following rhinoplasty. This systematic review aimed to assess the efficacy and safety of TAIs following rhinoplasty. We performed a systematic literature search on Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials from inception to May 2023, without any timeframe limitations. The following terms were used: (Triamcinolone OR steroid injections OR triamcinolone acetonide) AND (Skin thickness OR supratip edema OR supratip deformity OR Pollybeak deformity) AND (rhinoplasty OR external rhinoplasty). We included randomized controlled trials and observational studies (prospective, retrospective, and case series). In total, six of the 1604 articles met our inclusion criteria. A total of 1524 patients were included in this study. Our results included patient demographics, type of rhinoplasty, post-injection follow-up period, site of injection, type of syringe used, timing of the first dose, volume and concentration used, time interval between doses, response to the injection, and complications of injection. To our knowledge, this is the first systematic review to address this issue. Our results demonstrate the ease and safety of TAIs as a first-line treatment, with positive outcomes and limited complications. TAIs can be used early postoperatively to minimize the need for revision surgery. Despite the limited number of studies on TAIs, this study provides the best available evidence that can help surgeons decide when to use the injection, the intervals between doses, and the duration of use. Further randomized controlled trials are required to confirm our findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evaluating the Transfer of Injected Triamcinolone Acetonide into Human Milk: Confirmatory Results.

Evaluating the Transfer of Injected Triamcinolone Acetonide into Human Milk: Confirmatory Results.

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.

Scleritis following intravitreal brolucizumab injection: a case series

BackgroundThis study reports the first cases of scleritis following intravitreal brolucizumab (IVBr) injection for nAMD, emphasizing the need to be aware of the possibility of scleritis following IVBr injections.Case presentationCase 1. A 74-year-old Japanese man with nAMD complained of conjunctivitis and decreased vision in the right eye 8 days after his eighth IVBr injection. Examination revealed scleritis without anterior inflammation. Topical 0.1% betamethasone and 0.3% gatifloxacin eye drops were started. The scleritis worsened in the following 2 weeks and became painful. He underwent sub-Tenon’s capsule triamcinolone acetonide (STTA) injection. Two days later, he returned with a complaint of severe vision loss. Fundus examination revealed retinal artery occlusion, vasculitis, and vitreous opacity in the right eye. Vitreous surgery was performed. Case 2. An 85-year-old Japanese woman with nAMD in the right eye complained of reddening of the eye 27 days after her fifth IVBr injection. Examination showed conjunctivitis and scleritis without anterior inflammation in the right eye. She was started on 0.1% fluorometholone and 0.5% levofloxacin hydrate eye drops. The scleritis worsened in the following 3 weeks. Her treatment was switched to 0.1% betamethasone eye drops. One month later, the scleritis had improved and a sixth IVBr injection was administered. There was no worsening of the scleritis at that time. However, 1 month after a seventh IVBr injection, she complained of severe hyperemia and decreased vision. Fundus examination revealed vitreous opacification. She underwent STTA, and the vitreous opacity improved in 24 days. Case 3. A 57-year-old Japanese man with nAMD complained of pain and decreased vision in the right eye 21 days after a fourth IVBr injection. Examination revealed scleritis with high intraocular pressure but no anterior chamber or fundus inflammation. STTA and topical eye drops were performed. One month later, scleritis improved but visual acuity didn’t due to progression of nAMD.ConclusionsIntraocular inflammation following IVBr injection may progress to the posterior segment. Scleritis can occur after IVBr injection, and topical eye drops alone may not be sufficient for initial treatment. Clinicians should consider the possibility of scleritis in patients with worsening inflammation after IVBr injection.

Medial Epicanthal Fold Correction Using a Y-W Epicanthoplasty in Asian Eyelids.

Many surgical techniques for managing epicanthal folds have been reported, but their main drawbacks include a noticeable scar in Asians, acute medial canthal angle, and applicability only in mild or moderate epicanthal folds. This study described a novel surgical technique, Y-W epicanthoplasty, and assessed the medial canthal shape and scarring in patients who underwent Y-W epicanthoplasty. Patients with moderate or severe epicanthal folds between January 2004 and February 2017 were included in this study. Pre- and postoperative intercanthal distance (ICD), inner canthal angle (ICA), and interpupillary distance (IPD) were measured. The ICD ratios (ICD/IPD) and extent of postoperative scarring were evaluated. A Y-W epicanthoplasty was performed on 18 patients. The ICD ratio of the total study cohort showed a significant reduction following surgery (preoperative ICD ratio=0.62±0.04, postoperative ICD ratio=0.58±0.03, P<0.001). The ICA was 51.8±7.7° and 49.8±5.6° in the pre- and postoperative periods, respectively (P=0.086) Eleven patients showed no apparent scar, and 6 patients were found to have minimal scarring that was visible only under close inspection. One patient had a hypertrophic scar that was successfully managed with triamcinolone acetonide injections. Y-W epicanthoplasty can provide good aesthetic results without a visible scar in patients with moderate-to-severe epicanthal folds. The Y-W epicanthoplasty avoids a medially extended skin incision and excessive tension on the skin flaps. Moreover, an acutely shaped or webbed medial canthus after epicanthoplasty can be prevented by adding a small triangular flap. The Y-W epicanthoplasty procedure is simple and straightforward, and it is appropriate for moderate-to-severe epicanthal fold correction.

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When.

Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion of individuals with diabetes, with the prevalence increasing with disease duration and severity. It is estimated that approximately 25-30% of diabetic patients will develop DME during their lifetime. Poor glycemic control, hypertension, hyperlipidemia, diabetes duration, and genetic predisposition are recognized as risk factors for the development and progression of DME. Although the exact pathophysiology is still not completely understood, it has been demonstrated that chronic hyperglycemia triggers a cascade of biochemical processes, including increased oxidative stress, inflammation, activation of vascular endothelial growth factor (VEGF), cellular dysfunction, and apoptosis, with breakdown of the blood-retinal barriers and fluid accumulation within the macular area. Early diagnosis and appropriate management of DME are crucial for improving visual outcomes. Although the control of systemic risk factors still remains the most important strategy in DME treatment, intravitreal pharmacotherapy with anti-VEGF molecules or steroids is currently considered the first-line approach in DME patients, whereas macular laser photocoagulation and pars plana vitrectomy may be useful in selected cases. Available intravitreal steroids, including triamcinolone acetonide injections and dexamethasone and fluocinolone acetonide implants, exert their therapeutic effect by reducing inflammation, inhibiting VEGF expression, stabilizing the blood-retinal barrier and thus reducing vascular permeability. They have been demonstrated to be effective in reducing macular edema and improving visual outcomes in DME patients but are associated with a high risk of intraocular pressure elevation and cataract development, so their use requires an accurate patient selection. This manuscript aims to provide a comprehensive overview of the pathology, epidemiology, risk factors, physiopathology, clinical features, treatment mechanisms of actions, treatment options, prognosis, and ongoing clinical studies related to the treatment of DME, with particular consideration of intravitreal steroids therapy.

Effect of aflibercept combined with triamcinolone acetonide on aqueous humor growth factor and inflammatory mediators in diabetic macular edema.

To investigate the efficacy of aflibercept combined with sub-tenon injection of triamcinolone acetonide (TA) in treating diabetic macular edema (DME) and to examine changes in growth factors and inflammatory mediator levels in aqueous humor after injection. Totally 67 DME patients (67 eyes) and 30 cataract patients (32 eyes) were enrolled as the DME group and the control group, respectively. The DME group was divided into the aflibercept group (34 cases) and the aflibercept combined with TA group (combined group, 33 cases). The aqueous humor of both groups was collected during the study period. The aqueous levels of vascular endothelial growth factor (VEGF), monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-1β (IL-1β) were detected using a microsphere suspension array technology (Luminex 200TM). Aqueous cytokines, best-corrected visual acuity (BCVA), central macular thickness (CMT), and complications before and after treatment were compared between the aflibercept group and combined group. The concentrations of VEGF, MCP-1, IL-6, and IL-8 in the aqueous humor were significantly higher in the DME group than those of the control group (all P<0.01). After 1mo of surgery, the concentrations of VEGF, MCP-1, IL-6, and IL-8 in the aqueous humor were significantly lower in the combined group than those of the aflibercept group (all P<0.01). The BCVA and CMT values of the two groups were statistically different after 1 and 2mo of treatment (P<0.01). However, the difference was not statistically significant after 3mo of treatment (P>0.05). The cytokines VEGF, MCP-1, IL-6, and IL-8 in the aqueous humor of DME patients are significantly increased. Aflibercept and aflibercept combined with TA have good efficacy in DME patients, can effectively reduce CMT, improve the patient's vision, and have high safety. Aflibercept combined with TA can quickly down-regulate the aqueous humor cytokines and help to relieve macular edema rapidly. However, the long-term efficacy is comparable to that of aflibercept alone.

Comparison of Changes in Quality of Life Based on Changes in Disease Severity in Graves Ophthalmopathy Patients Following Intraorbital Triamcinolone Acetonide Injection

Abstract&#x0D; Introduction &amp; Objectives : Graves ophthalmopathy (GO) is associated with visual impairment and appearance changes, affecting the quality of life. Intraorbital injection of triamcinolone acetonide (TCA) in GO resulted in clinical improvement, but its effect on the quality of life is unknown. The objective of this study was to compare the changes in quality of life after intraorbital injection of TCA between different groups based on changes in disease severity.&#x0D; Methods : Intraorbital injection of TCA was performed on 30 subjects with GO. Disease severity was assessed according to the European Group of Graves Ophthalmopathy (EUGOGO) criteria. Quality of life was measured using the Indonesian version of Graves Ophthalmopathy Quality of Life (GO-QOL) questionnaire. Changes in disease severity and GO-QOL scores were recorded before intraorbital injection of TCA and 1 month after. Subjects were divided into groups based on changes in disease severity: decreased, remained constant, and increased. Changes in quality of life between the groups were compared statistically.&#x0D; Results : Changes in GO-QOL appearance scores in patients with decreased disease severity were significantly higher (p= 0.016) than those in patients whose disease severity remained constant. Changes in GO-QOL visual function scores in patients with decreased disease severity were higher but not statistically significant (p&gt; 0.05) compared to those in patients whose disease severity remained constant.&#x0D; Conclusion : Changes in the appearance aspect of quality of life after intraorbital injection of TCA in patients with decreased disease severity are better than that in patients whose disease severity remained constant, whereas changes in the visual function aspect are not significantly different.

The Effect of Intracameral Triamcinolone Acetonide on Controlling Common Complications following Phacoemulsification in Dogs.

The intracameral injection of triamcinolone acetonide (TA) has achieved favorable clinical effects in controlling intraocular inflammatory reactions in humans after cataract surgery. However, the effect of this method remains unclear in veterinary practice. In this paper, 18 dogs with bilateral cataracts were randomly divided into three groups, with 6 dogs in each group. Phacoemulsification and intraocular lens implantation were performed on the 36 eyes of these dogs. A total of 0.1 mL of TA solution was injected into the oculus dexter (OD) anterior chambers. All oculus sinister (OS) anterior chambers of these dogs were used as controls. The results demonstrated that the corneal edema severity scores of the OD (1.5 mg TA) were lower than those of the OS from the 1st to 7th day after surgery, with a significant difference on the 3rd day after surgery (p = 0.033). The corneal edema severity scores in the OD (1.5 mg TA) were significantly lower than those in the OD (0.5 mg TA) on the 3rd day after surgery (p = 0.036). The aqueous humor protein concentration of the OD (1.5 mg TA) had a lower concentration than the OS on the 1st day after surgery (p = 0.004). Furthermore, on the 5th and 10th days, the aqueous humor protein concentration of the OD (1.5 mg TA) was lower than that of the OS (p = 0.038 and p = 0.044, respectively). The aqueous humor PGE2 concentration of the OD (1.5 mg TA) had a lower concentration than the OS on the 1st day after surgery (p = 0.026). The aqueous humor PGE2 concentrations in the OD (1.0 mg TA) and OD (1.5 mg TA) were lower compared to that in the OD (0.5 mg TA) on the 1st day after surgery (p = 0.041 and p = 0.037, respectively). It was demonstrated that TA-based treatment can be safely employed to effectively control common complications after phacoemulsification in dogs.