Efficacy of adjuvant mitomycin-C and triamcinoloneimpregnated nasal packing for endoscopic dacryocystorhinostomy

●AIM:To compare the success rate and complications of adjuvant use of mitomycin C and triamcinoloneimpregnated biodegradable nasal packing(TABP)in endoscopic dacryocystorhinostomy(DCR).And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR.●METHODS:A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed.The patients were randomly divided into three groups:Group A included patients treated without intraoperative mitomycin C but with TABP,Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing,and Group C included patients treated with intraoperative mitomycin C and TABP.●RESULTS:The results revealed no significant difference in the overall success rates between Groups A(86.8%)and B(89.2%;P=0.377).However,Group C(97.5%)showed a significantly higher overall success rate than Groups A and B.The incidence of granulomas was significantly lower in group C(5%)than in Groups A(20.8%)and B(15.2%;P=0.009).Other complications,such as crust,synechiae,and revision surgery,did not differ significantly among the three groups.●CONCLUSION:The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate.Additionally,there is no statistically significant difference observed between the use of mitomycin C or TABP alone.

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

AIM: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.METHODS: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.RESULTS: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).CONCLUSION: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 downregulate the aqueous humor cytokines and help to relieve macular edema rapidly.However,the long-term efficacy is comparable to that of aflibercept alone.

Complications of intravitreal triamcinolone acetonide for macular edema and predictive factors for intraocular pressure elevation

AIM: To investigate the complications of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema, and to determine the risk factors for intraocular pressure (IOP) elevation. METHODS: Charts of patients with macular edema secondary to branch retinal vein occlusion (BRVO), diabetic retinopathy and uveitis who had received IVTA injections were reviewed to document its complications. IOP elevation was defined as a pressure of ≥24mmHg at some point during follow-up. Multivariate logistic regression analysis was performed to characterize baseline risk factors for this elevation. RESULTS: The study included 111 eyes of 65 female and 46 male patients with a mean follow-up of (11.6±5.1) months. Of the 111 eyes, 52 (46.8%) had macular edema secondary to BRVO, 44 (39.6%) had clinically significant diabetic macular edema (CSDME) and 15 (13.5%) had non-infectious uveitis with macular edema. IOP was recorded ≥24mmHg in 38 eyes (34.2%) during the follow-up. Higher baseline IOP (P =0.022), younger age (P =0.003), and male gender (P = 0.014) were significant risk factors for IOP elevation after IVTA injection. Eyes with prior vitrectomy were less likely to have IOP elevation (P =0.054). Two eyes (5.2% of eyes with increased IOP) underwent trabeculectomy, and 9 eyes (16.3% of the phakic eyes) necessitated cataract surgery. Other complications included branch vein occlusion (1.8%), sterile endophthalmitis (0.9%) and pseudohypopyon (0.9%). CONCLUSION: IVTA has side effects with IOP elevation and cataract formation being the two most common. A subset of patients is more prone to developing increased IOP following IVTA, namely, younger male patients with higher baseline IOP.

Role of triamcinolone in radiation enteritis management

AIM:To investigate the role of triamcinolone in the management of acute and chronic enteritis caused by pelvic radiotherapy.METHODS:Twenty-eight patients with rectum adenocarcinoma or endometrium adenocarcinoma were studied.We compared the results of 14 patients treated with injected triamcinolone acetonide(TA)with those of 14 patients who were not treated with TA.For the TA group,40 mg of TA was injected intramuscularly on the 1st,11th and 21st d of radiotherapy;the control group received no injections.All of the study participants had a median age of 65 years,had undergone postoperative radiotherapy and were evaluated weekly using Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer Acute Morbidity Score Criteria,and complete blood counts for every 10 d.RESULTS:Triamcinolone was found to effectively prevent and treat radiation-induced acute gastrointestinal(enteritis)and genitourinary(cystitis)side effects(P=0.022 and P=0.023).For the lower GI side effect follow up,11 patients in the control group had Grade 2toxicity and 3 patients had Grade 1 toxicity.In the TA group,5 patients had Grade 2 toxicity and 9 patients had Grade 1 toxicity.For the genitourinary system side effect follow up,4 patients had Grade 2 toxicity and 6patients had Grade 1 toxicity.Additionally,2 patients had Grade 2 toxicity and 2 patients had Grade 1 toxicity.The neutrophil counts did not differ between the TA group and the control group.There was no meaningful difference between age groups and primary cancers.At the 12th mo of follow up,there were no differences between groups for chronic side effects.CONCLUSION:Triamcinolone is a moderately potent steroid,that is inexpensive and has a good safety profile.It would be beneficial for reducing medical expenses related to treatment of radiation induced enteritis.

Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion

AIM:To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion(CRVO) in Chinese patients.· METHODS:Seventy-five eyes of 75 patients were enrolled in this prospective,randomized,consecutive study.Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab(1.25mg/0.05mL),and 39 patients in group 2 were treated with intravitreal bevacizumab(1.25mg/0.05mL) combined with triamcinolone acetonide(2mg/0.05mL).The main outcomes of the mean best corrected visual acuity(BCVA),central retinal thickness(CRT),and intraocular pressure(IOP) were measured.· RESULTS:In group 1,the mean BCVA improved from 37.78±6.14(baseline) to 48.06±3.86,46.48±4.77 and 44.18±5.78 at four,six and twelve weeks post-injection,respectively(P<0.01,P =0.03,P=0.04).In group 2,the mean BCVA improved from 35.92±6.20(baseline) to 50.69±4.22,48.76±5.59 and 45.70±6.56 at the same time points(P<0.01 each).However,there was no significant differences in the mean BCVA(F =0.043,P=0.836) and CRT(F=0.374,P =0.544) between these two groups.During the follow-up,five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs.CONCLUSION:Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO,but there is no significant difference between the two groups.

Macular laser photocoagulation with or without intravitreal triamcinolone pretreatment for diabetic macular edema： a result from five randomized controlled trials

AIM:To assess possible benefits of intravitreal triamcinolone acetonide(IVTA)injection as pretreatment for macular laser photocoagulation(MLP)in patients with diabetic macular edema(DME).·METHODS:Published randomized controlled trials(RCTs)concerning MLP with or without IVTA pretreatment for DME were retrieved from databases CNKI,Medline,EMbase,Web of Science,and the Cochrane Library.A Meta-analysis on eligible studies was conducted using Rev Man 5.0 software.Two investigators independently assessed the quality of the trials and extracted data.Main outcome measures included the change in best-corrected visual acuity(BCVA),difference in central macular thickness(CMT)and adverse events reporting in particular elevated intraocular pressure within the follow-up period.The results were pooled using weight mean difference(WMD)or odds risk(OR)with their corresponding 95%confidence intervals(CI).A fixed-or random-effect model was employed depending on the heterogeneity of the inclusion trials.·RESULTS:Finally,five independent RCTs were identified and used for comparing MLP with IVTA pretreatment(131 eyes)with MLP alone(133 eyes,control group).The overall study quality was relatively higher according to the modified Jadad scale.The Metaanalysis showed that MLP with IVTA pretreatment significantly reduced CMT at one,three and six months(P=0.002,0.0003 and 0.04,respectively),compared with MLP alone.The IVTA pretreatment group showed statistically significant improvements in BCVA at the one-month follow up as compared with the control group(P=0.03).At three-and six-month follow up,there was a beneficial trend towards improving visual acuity in the IVTA pretreatment group without statistical significance between groups(P=0.06 and 0.20,respectively).The incidence of elevation of intraocular pressure was significantly higher in the IVTA pretreatment group than in the control group(P<0.0001).No evidence of publication bias was present according to Begg's test and Egger's test.There was a low level of heterogeneity in the included studies.·CONCLUSION:This Meta-analysis indicates that MLP with IVTA pretreatment has a better therapeutic effect in terms of CMT reduction and earlier(1mo)visual improvement for patients with DME as compared with MLP alone.Further confirmation with rigorously welldesigned multi-center trials is needed.

Comparison of intravitreal bevacizumab and triamcinolone acetonide theraphies for diffuse diabetic macular edema

AIM: To compare therapeutic effects of intravitreal triamcinolone acetonide(IVTA) versus intravitreal bevacizumab(IVB) injections for bilateral diffuse diabetic macular edema(DDME). METHODS: Forty eyes of 20 patients with bilateral DDME participated in this study. For each patient, 4 mg/0.1 m L IVTA was injected to one eye and 2.5 mg/0.1 m L IVB was injected to the other eye. The effects of injection for diabetic macular edema(DME) were evaluated using best-corrected visual acuity(BCVA), central macular thickness(CMT) by optical coherence tomography(OCT)and intraocular pressure(IOP) by applanation tonometer.Patients underwent eye examinations, including BCVA,CMT, and IOP at pre-injection, 1, 4, 8, 12 and 24 wk after injection. During the follow-up, second injections were performed to eyes which have CMT greater than 400 μm at 12 wk for salvage therapy.RESULTS: BCVA(logarithm of the minimum angle of resolution) at pre-injection, 1, 4, 8, 12 and 24 wk after injection was 0.71 ±0.19, 0.62 ±0.23, 0.63 ±0.12, 0.63 ±0.13,0.63±0.14 and 0.61±0.24 in the IVTA group and 0.68±0.25,0.61 ±0.22, 0.60 ±0.24, 0.62 ±0.25, 0.65 ±0.26 and 0.59 ±0.25 in the IVB group, respectively. CMT(μm) at pre-injection,1, 4, 8, 12 and 24 wk after injection was 544 ±125, 383±96,335 ±87, 323 ±87, 333 ±92, 335 ±61 in the IVTA group and514 ±100, 431 ±86, 428 ±107, 442 ±106, 478 ±112, 430 ±88 in the IVB group respectively. Reduction ratios of mean CMT were 29% at 1wk, 38% at 4wk, 40% at 8wk, 38% at12 wk, and 38% at 24 wk in the IVTA group. Second IVTA injections were performed to the 6 eyes(30%) at 12 wk.Reduction ratios of mean CMT were 16% at 1wk, 17% at4wk, 14% at 8wk, 7% at 12 wk, and 16% at 24 wk in the IVB group. Second IVB injections were performed to the15 eyes(75%) at 12 wk.CONCLUSION: This study showed earlier and more frequent macular edema recurrences in the eyes treated with bevacizumab compared with the ones treated with triamcinolone acetonide. Triamcinolone acetonide was found to provide more efficient and long-standing effect in terms of reducing CMT compared with the bevacizumab.

Intravitreal triamcinolone versus intravitreal bevacizumab for diabetic macular edema:a meta-analysis

AIM:To compare the efficacy of the sole intravitreal triamcinolone(IVT) versus intravitreal bevacizumab(IVB)alone or IVB combined with IVT in the treatment of diabetic macular edema(DME).·METHODS:Pertinent publications were identified through systematic searches of database and manually searching.Methodological quality of the literatures was valuated according to the Jadad Score.RevMan 5.1.0was used to do the meta-analysis.Heterogeneity was determined and sensitivity was conducted.·RESULTS:Six studies were ultimately included in the meta-analysis.The results of our analysis showed IVT had a statistically significant improvement in vision over the IVB at 1 month and 3 months(P<0.01).However,the reduction was not significant regarding central macular thickness(CMT) during the earlier(1 month and 3months) follow-up period(P =0.12,P =0.41,respectively).At later visit(6 months),IVT had a significant decrease in CMT when compared to IVB(P<0.01) while no significant improvement in visual acuity(VA) was observed(P =0.14).The incidence of intraocular hypertension was 13/102 in IVT group during follow-up period while 0/103 in IVB group.The difference was significant(P <0.01).With regards to IVT versus IVB combined with IVT,there were no significant differences in CMT at 1 month(P =0.86)and 3 months(P =0.06).The incidence of intraocular hypertension was 6/67 in IVT group during follow-up period while 4/66 in IVB +IVT group.But the difference was not significant(P =0.53).·CONCLUSION:Current evidence shows IVT is superior in improving VA at earlier follow-up(1 month and 3months) and in reducing CMT at later follow-up(6months) for DME.At other time,it is in favor of IVT treatment but there are no statistically significances.However,IVT has the side-effect of ocular hypertension.There is no adequate evidence of the benefit adding IVB to IVT in contrast to IVT alone.

Short-term effects of intravitreal triamcinolone acetonide injection on ocular blood flow evaluated with color Doppler ultrasonography

AIM:To evaluate the changes in ocular blood flow with color Doppler ultrasonography(CDU) after intravitreal triamcinolone acetonide(IVTA) injection.METHODS:A total of 46 patients who underwent IVTA(4 mg/0.1 mL) injection for diabetic macular edema(DME)(n =22), central retinal vein occlusion(CRVO)(n =12) and choroidal neovascular membrane(CNVM)(n =12) were included in the study. Peak systolic velocity(PSV), end diastolic velocity(EDV) and resistivity index(RI) were measured from the ophthalmic artery(OA), the central retinal artery(CRA) and the posterior ciliary artery(PCA)of each patient with CDU before, at the end of the first week and at the end of the first month following IVTA injection.RESULTS:In the DME group, PSV of OA at the first of the first month(mean ±SD)(37.48 ±10.87 cm/s) increased compared to pre-injection value(31.39 ±10.84 cm/s)(P =0.048). There was a statistically significant decrease(P =0.049) in PSV of CRA at the end of the first month(7.97±2.67 cm/s) compared to the pre-injection(9.47±3.37 cm/s).There was not any statistically significant difference onthe other parameters in the DME group. Also, there was not any statistically significant difference on the ocular blood flow values in the CRVO and CNVM groups.CONCLUSION:We observed that 4 mg/0.1 mL IVTA increased PSV of OA and decreased PSV of CRA in DME patients and did not have any effect on ocular blood flow values of CRVO and CNVM patients.

Comparison of intravitreal bevacizumab with intravitreal triamcinolone acetonide for treatment of cystoid macular edema secondary to retinal vein occlusion : a Meta-analysis

AIM: To compare the effects of intravitreal injection of bevacizumab(IVB) with intravitreal triamcinolone acetonide(IVTA) on the treatment of cystoid macular edema(CME) secondary to retinal vein occlusion(RVO).·METHODS: A literature search was conducted using Pub Med, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. The comparison was divided into two groups,group 1 conducted comparison in branch RVO(BRVO) or central RVO(CRVO), group 2 conducted comparison in ischemic-RVO or nonischemic-RVO. Pooled mean differences(MDs) for changes in visual acuity(VA),central macular thickness(CMT) and intraocular pressure(IOP) were calculated in groups at 4, 12 and 24 wk after treatment respectively.·RESULTS: Eight studies comparing the efficacy of IVB with IVTA were included in the Meta-analysis. In group 1,in BRVO, significant difference was shown on the comparison of CMT at 24wk(MD,-45.66; 95% CI,-76.03to-15.28; P =0.003), IVB was effective on BRVO for at least 24wk; no significant differences were found in the comparison of VA at each time points(P >0.05respectively). In CRVO, no significant differences were found in the comparison of VA or CMT between IVB and IVTA at each time points(P >0.05, respectively). In group2, in ischemic-RVO, significant differences were shown in the comparison of VA(MD,-0.28; 95% CI,-0.42 to-0.14;P <0.0001) and CMT(MD,-86.50; 95% CI,-151.18 to-22.43;P =0.008) at 24wk; In nonischemic-RVO, no significant differences were demonstrated in the comparison of VA or CMT between IVB and IVTA at each time points(P >0.05, respectively). The occurrence of high IOP was much lower in IVB group.·CONCLUSION: This Meta-analysis suggested that IVB was effective in decreasing CMT in BRVO for at least24 wk, IVB is more effective on improving VA and reducing CMT in ischemic-RVO. IVB is more promising on RVO than IVTA.

Comparison of intravitreal injection of conbercept and triamcinolone acetonide for macular edema secondary to branch retinal vein occlusion

AIM:To compare the safety and efficacy of the intravitreal injection of conbercept(IVC)and triamcinolone acetonide(IVTA)for macular edema(ME)secondary to branch retinal vein occlusion(BRVO).METHODS:A prospective,randomized clinical study.Patients with ME secondary to BRVO were randomly assigned to either IVC group or IVTA group at a ratio of 2:1 and a 12-month follow-up was performed.The efficacy outcome measures included the mean changes and differences in best corrected visual acuity(BCVA)and the central retinal thickness(CRT).The safety profiles and the mean retreatment intervals were also compared.RESULTS:There was no statistically significant difference of baseline between the two groups(IVC group,n=36;IVTA group,n=17).At 12mof the BCVA letters improved by 27.31±18.36 in the IVC group,and 13.53±11.37 in the IVTA group(P=0.0004).CRT reduction was 253.33±163.69 and 150.24±134.32 pm,respectively(P=0.0034).The mean BCVA in the IVC group was superior to that of the IVTA group for months 6-12(P<0.01).The mean CRT at 9 and 12mo were thinner in the IVC group compared to the IVTA group(P<0.01).The mean retreatment interval in the IVC group was longer than that in the IVTA group(97.40±36.27d vs 68.71±36.38d,P=0.0030).One eye in the IVC group and seven eyes in the IVTA group developed elevated intraocular pressure(IOP;P=0.0012).The proportion of eyes with cataract new-onset or progression were 19.44%in the IVC group and 64.71%in the IVTA group(P=0.0012).CONCLUSION:IVC could maintain or improve BCVA and reduce CRT for a longer time and have longer retreatment interval than IVTA.In addition,patients treated with IVTA are more susceptible to IOP elevation and cataract progression.

Long-term effect of triamcinolone acetonide in the treatment of upper lid retraction with thyroid associated ophthalmopathy

AIM: To report the long-term outcomes of a large cohort of upper lid retraction patients treated with subconjunctival triamcinolone acetonide injections.METHODS: This retrospective clinical study was conducted from 2009 to 2016. The documents of 97 patients(126 eyes) were reviewed. The patients were treated with subconjunctival triamcinolone acetonide injections monthly and evaluated pre-and post-treatment by taking measurements of the upper margin reflex distance(MRD1, the distance between the upper-lid margin and the pupil center), lid aperture, lagophthalmos and proptosis. The patients were divided into the cured group, the improved group and the ineffective group based on the final treatment effectiveness. The improved group and the ineffective group were combined into non-cured group.RESULTS: The follow-up time was 23.45±14.86 mo. Of the patients, 63(64.9%) were assigned to the cured group, 22(22.7%) in the improved group, 12(12.4%) in the ineffective group. Injection times for cured group was 4.66±1.74, and for non-cured group was 5.17±2.08(P≤0.05). The MRD1 was significantly reduced between baseline and 1 mo after the initiation of treatment in the cured and improved groups(P<0.001). The values did not change significantly after 4 mo for the improved group, while they continued to decrease in the cured group. In the ineffective group, the MRD1 did not significantly change after treatment. A statistically significant difference was observed between the baseline and post-treatment values of the mean muscle thickness(2.95±0.99 mm vs 2.04±0.63 mm, P<0.05) and surface area(27.27±10.5 mm2 vs 18.3±7.04 mm2,P<0.05) of the levator superioris with magnetic resonance imaging examination. Twelve patients(12.4%) relapsed after treatment and required additional subconjunctival injections. The main side effects included menstrual cycle disturbances(32%) and elevations of intra-ocular pressure(18.6%). CONCLUSION: A repeated subconjunctival injection of triamcinolone is an effective and relatively safe treatment for upper lid retraction due to thyroid-associated ophthalmopathy. This is related to the anti-inflammation effect of the medicine and the levator thickness can become thinner. Patients must be monitored regularly for recurrences and side effects.

Triamcinolone as an adjunct to the combination of anti-VEGF for the management of diabetic macular edema

AIM:To assess the efficacy of intravitreal triamcinolone(IVTA)as an adjunct to the combination of anti-vascular endothelial growth factor(VEGF)for the management of diabetic macular edema(DME).METHODS:A total of 51 patients with visual disabilities causing by DME from two sites were retrospectively collected and assigned to two groups according to the therapeutic method:intravitreal conbercept(IVC)combined with focal laser(24 eyes)and IVC combined with focal laser and IVTA(27 eyes).Best-corrected visual acuity(BCVA),the required number of IVCs,central retinal thickness(CRT),the mean costs of treatment burden and safety were compared over 12 mo.RESULTS:From baseline to month 1 through month 12,IVC combined with focal laser and IVTA improved the mean average change in BCVA superior to IVC combined with focal laser(+5.20 vs+2.71 letters).At month 12,20.83%of the IVC combined with focal laser and 37.04%of IVC combined with focal laser and IVTA arms gained more than 10 BCVA letters.During the period,the mean CRT decreased significantly in the IVC combined with focal laser and IVTA arm(-245.9μm)compared to the IVC combined with focal laser arm(-98.45μm).The average of 6.45 and 1.25 conbercept injections performed in the IVC combined with focal laser and IVC combined with focal laser and IVTA arms,respectively.The mean cost of treatment burden for 12 mo was$6247.44±4069.18 in the IVC combined with focal laser arm and$1679.19±542.73 in the IVC combined with focal laser and IVTA arm,with a statistically significant difference.Apart from occasional minor subconjunctival hemorrhage,no other significant ocular adverse events(AEs)were observed in either group during the 12-month period.CONCLUSION:It is effective and cost-effective to treat DME by utilizing triamcinolone as an adjunct to the combination of anti-VEGF.

Intravitreal triamcinolone acetonide： a ＂real world＂ analysis of visual acuity, pressure and outcomes

Dear Sir,Triamcinolone acetonide(TA)is worldwide available therapeutic agent that is commonly used throughout medicine.TA remains a safe and important ophthalmic therapeutic agent even after the advent of angiogenesis inhibitors[1-2].Intravitreal TA effectiveness has been demonstrated either alone or combined with other

Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases

BACKGROUND Intravitreal injection has become an efficient approach for delivering drugs at therapeutic levels to the posterior segment in retinal diseases.However,the increased frequency and number of intravitreal injections have raised concerns about their side effects.As manipulation during surgery is relatively simple,details of the procedure are easily overlooked.Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures.We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide(TA)with the hope of providing an insight into this treatment.CASE SUMMARY Case 1 was a 62-year-old woman with macular edema caused by central retinal vein occlusion in her right eye,and Case 2 was a 65-year-old man with macular edema caused by branch retinal vein occlusion in his right eye.In view of the patients’condition and economic constraints,an intravitreal injection of TA was administered.Due to inappropriate manipulation during surgery,the lens was injured.The site of lens injury and clinical manifestations were different in the two cases.Symptomatic treatment and continuous follow-up were carried out.The therapeutic effect following phacoemulsification of the cataract was satisfactory.CONCLUSION Well-defined surgical incision under proper anesthesia,sufficient patient information and proficient anatomical skills of the physician are mandatory to prevent this rare adverse event.Careful and meticulous phacoemulsification of the cataract is suggested.

Ocular hypertension and severe intraocular pressure elevation after posterior subtenon injection of triamcinolone acetonide for various diseases

AIM:To evaluate and compare the incidences of ocular hyper tension and severe intraocular pressure(IOP)elevation after posterior subtenon injection of triamcinolone acetonide(PSTA)for various diseases.METHODS:Totally 179 eyes that had received PSTA for diabetic macular edema(n=108),pseudophakic cystoid macular edema(n=20),branch retinal vein occlusion(n=16),central retinal vein occlusion(CRVO,n=14),choroidal neovascularization(n=14)or noninfectious uveitis(n=7)were retrospectively enrolled.The primary outcomes included ocular hypertension defined as an IOP>21 mm Hg,and severe IOP elevation defined as a rise of 10 mm Hg or more in IOP compared with baseline.Cox regression models were used to analyze the hazard ratios(HRs)among different diseases.RESULTS:After PSTA,the mean IOPs from month 1 to month 6 all significantly increased(P<0.05).Ocular hypertension occurred in 30.7%of eyes(median time:8 wk),and severe IOP elevation occurred in 16.2%of eyes(median time:9 wk).Patients receiving PSTA for CRVO or uveitis had a significantly higher risk for ocular hypertension(HR=3.049,P=0.004 for CRVO;HR=5.464,P=0.019 for uveitis)and severe IOP elevation(HR=2.913,P=0.034 for CRVO;HR=7.650,P=0.009 for uveitis).CONCLUSION:IOP significantly increases within 6 mo after PSTA,with the onset of ocular hypertension happening mostly at 2 to 3 mo.Patients of CRVO or noninfectious uveitis have a higher risk of ocular hypertension or severe IOP elevation after PSTA and should be monitored for IOP more carefully.

Low-dose intralesional injection of 5-fluorouracil and triamcinolone reduces tissue resident memory T cells in chronic eczema

BACKGROUND Tissue resident memory T(TRM)cells have been reported to play a significant role in the pathogenesis and relapse of chronic eczema.AIM To compare the efficacy and safety of the intralesional injection of 5-fluorouracil(5-FU)and triamcinolone(TA)with those associated with TA alone for the treatment of chronic eczema.METHODS A total of 168 patients were randomized to 5-FU+TA or TA groups and received a one-time intralesional injection of 5-FU+TA or TA only.Biopsies were collected before and 2 wk after treatment for evaluation of histopathological changes.All patients were followed up monthly for up to 1 year.RESULTS No serious adverse event was observed in either group.Although the mean atopic dermatitis severity index scores and effective rates were comparable between the two groups after 2 wk of treatment,the relapse rate was significantly lower in the 5-FU+TA group than in the TA group.Histological examination showed significantly fewer CD8^(+)and CD103^(+)T cells but not CD4^(+)T cells in the 5-FU+TA group.CONCLUSION One-time intralesional injection of 5-FU+TA is effective and safe for chronic eczema treatment and can further reduce the retention of T_(RM) cells in the lesional skin and the relapse rate of chronic eczema.

Debulking of Keloid Combined with Intralesional Injection of 5-Flurouracil and Triamcinolone versus Intralesional Injection of 5-Flurouracil and Triamcinolone

Background: A wide range of therapies exist for keloids. But despite the multiple treatment modalities available, keloids still remain a significant challenge for both the clinician and the patient. Objective: To assess the effectiveness and safety of debulking of keloid with intralesional injection of 5-flurouracil and triamcinolone in comparison to intralesional injection of 5-flurouracil and triamcinolone alone. Patient and Methods: This single blinded comparative therapeutic outpatient based study was done at the Department of Dermatology, Baghdad Teaching Hospital during the period from February 2011 to February 2013. Twenty-three patients with 52 lesions were enrolled in the study and consisted of two groups: Group A (26 lesions): Treated by intralesional injection of combination of 5-flurouracil and triamcinolone acetonide and repeated every month;Group B (26 lesions): Debulking was carried out first and then injection of combination of 5-flurouracil and triamcinolone acetonide at time of operation and then repeated injection monthly. Evaluation was performed by scoring system with 5 criteria (redness, elevation, hardness, itching and tenderness). The response was graded as no response, minimal, moderate or complete response. Results: Both modalities of treatments showed significant results in treating keloid, but the intralesional therapy alone was slightly better than debulking plus intralesional and no systemic adverse effects were noticed in both groups. Conclusion: Both modalities of therapy were effective in treatment of keloid, and there was no much difference between them.

Macular atrophy after combined intravitreal triamcinolone and photodynamic therapy to treat choroidal neovascularization

AIM:To report the appearance of choriocapillaris atrophy after combined high dose intravitreal triamcinolone acetonide (TA)and photodynamic therapy(PDT)to treat choroidal neovascularization(CNV)associated with age related macular degeneration(AMD). METHODS:The present study was retrospective about non-randomized interventional case series.Fifty-one consecutive eyes with subfoveal(all types)CNV associated with AMD were treated by PDT and intravitreal(19.4±2.1)mg per O.1mL TA at the Alicante Institute of Ophthalmology.The appearance of macular choriocapillaris and retinal pigment epithelium(RPE)atrophy was considered at two years follow-up.Thirty consecutive eyes treated by PDT alone, matched for age,sex,and type and size of CNV were considered as control group. RESULTS:Twenty-one of 47 eyes in the study group(45%) and 7 of 30 eyes in the control group(23%)developed macular RPE and choriocapillaris atrophy in the treated area at month 24(P=0.04,Chi-square test).The greatest diameter of the atrophic areas averaged(5044±1666)μm in the study group vs(4345±1550)μm in the control group. Mean final best corrected visual acuity(logarithm of minimal angle of resolution)was(0.87±0.33)in the cases with RPE atrophy vs(0.66±0.26)in the cases with no RPE atrophy in the study group(P=0.11,Mann-Whitney U test). CONCLUSION:The association of high doses of intravitreal TA and PDT may increase the risk for RPE and choriocapillaris atrophy.

Safety of intravitreal triamcinolone acetonide:an electrophysiologic and histopathological study in rabbits

AIM:To evaluate the retinal safety of various doses of intravitreal triamcinolone acetonide(TA)in rabbits.METHODS:Thirty New Zealand albino rabbits were divided into five groups(six animals each).In group 1(control group),each animal received a single intravitreal injection of 0.1 mL phosphate buffered saline.In groups2,3,4 and 5,each rabbit received a single intravitreal injection of 4,8,16 and 32mg of TA,respectively.Each dose was contained in 0.1 mL phosphate buffered saline.Clinical ocular examinations were performed before the injection and on the 1st,3rd,10th and 17th postinjection days.A standard dark adapted electroretinogram(ERG)was obtained before injection and on the 3rd,10th and 17th post-injection days.After17d,animals were sacrificed and their eyes prepared for pathological examination.RESULTS:By monitoring ERG as a functional index for the retina,intravitreal injection of 4mg TA showed no significant ERG changes.At doses of 8,16 and 32,hyper-abnormal responses in a-and b-waves of ERG were detected on the 3rd post-injection day.These changes gradually returned back to normal limits after17d.Histopathological examination of the retina of all animals showed no pathological changes.CONCLUSION:High doses of intravitreal TA seemed to have enhancing effects on the retinal function with gradual return to normal limits with no pathological changes detected in examined eyes.