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Purpose: Refractory or recurrent vitreous seeds account for a large proportion of failure of eye salvage in retinoblastoma. The purpose of this study is to evaluate the efficacy of periocular topotecan (POT) in the management of vitreous seeds in retinoblastoma. Methods: Retrospective, interventional study of patients with retinoblastoma with vitreous seeds who received POT concurrent with intravenous chemotherapy (IVC). Results: Thirty-eight eyes of 35 patients received POT. Five eyes (13%) belonged to International Classification of Retinoblastoma group C, 23 eyes (61%) belonged to group D, and 10 eyes (26%) belonged to group E. Primary treatment included IVC with a combination of carboplatin, etoposide, and vincristine for a mean of 6 cycles (median 6; range 6–9). Concurrent to IVC from the fourth cycle onward, all patients received POT. Focal vitreous seeds were present in 20 eyes (53%) which received a mean of 3 injections (median 3; range 1–7). Diffuse vitreous seeds were present in 18 eyes (47%) which received a mean of 4 injections (median 5; range 1–7). At a mean follow-up of 8.5 months (median 5 months; range 1–15 months), regression of focal and diffuse vitreous seeds was achieved in 16 eyes (80%) and 8 eyes (44%), respectively. In all, 24 eyes (63%) had complete remission of vitreous seeds with POT given concurrently with IVC. Eye salvage was possible in 19 eyes (95%) with focal vitreous seeds and 12 eyes (68%) with diffuse VS. Enucleation was necessary for persistent vitreous seeds and viable tumor in five eyes (13%), viable tumor alone in one eye (0.02%), and recurrent vitreous seeds in one eye (0.02%). None of the patients developed systemic metastasis. Conclusion: POT administered concurrent with IVC is safe and effective in the initial management of vitreous seeds.
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AIM: To determine the pharmacokinetics and distrubution of methylprednisolone sodium succinate ( MPS ) and its metabolic product methylprednisolone ( MP ) in eye tissues and blood plasma after MPS periocular injection in rabbits.?METHODS:After periocular injection of MPS 10mg, the concentrations for MP and its prodrug conmpound were quantified at different time points using mass spectrum-liquid chromatography in plasma and ocular tissues -slera, choroid and retina, vitreous, iris, aqueous humor, lens and optic nerve.? RESULTS: After periocular injection, the time of maximum concentration ( Tmax ) for MPS in ocular tissues was 0. 25 to 1h, in blood plasma was 0. 25h. Tmax for its metablite MP in ocular tissues was 0. 5 to 6h, in blood plasma was 0. 5h. The maximum MPS and MP concentration ( Cmax ) and the area under the curve ( AUC0-t ) in ocular tissues from high to low in turn was sclera, optic nerve, the choroid and the retina, iris and lens. The drug concentration of lens was not only the lowest among all tissues, but also much lower than others by far the content, and its mean residence time was the longest.?CONCLUSION: Periocular administration of MPS is an effective way to intraocular drug transmission. It achieves a satisfactory drug distribution in sclera, optic nerve,choroid and retina. It is not easily absorbed by lens.
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PURPOSE: The aim of this study is to evaluate the effects and complications of mixed injections of botulinum neurotoxin A (BoNT-A), triamcinolone acetonide, 5-fluorouracil (5-FU) in patients with Graves upper eyelid retraction. METHODS: Twenty-four eyes of 17 patients with a mean age of 43.9 years showed symptoms of Grave's upper eyelid retraction (GUER). They received mixed injections of BoNT-A 4 IU/0.1 mL, triamcinolone acetonide 4 mg/0.1 mL and 5-FU 5 mg/0.1 mL via subconjunctival injection. The response to treatment and the presence of adverse effects were followed up for 9.0 ± 6.0 months and evaluated retrospectively. RESULTS: Margin reflex distance 1 decreased significantly from 5.6 ± 1.2 mm to 4.7 ± 1.1 mm at 1 month after injection. Tarsal platform show increased significantly from 1.4 ± 1.3 mm to 1.8 ± 1.3 mm, and tear break up time increased significantly from 5.2 ± 3.1 seconds to 10.3 ± 7.8 seconds. When success was defined as the correction amount of GUER being larger than 1 mm, the success rate was 66.7%. Kaplan-Meier survival analysis showed that GUER correction effects last longer in patients with a duration of disease longer than 6 months. There were no severe adverse effects such as diplopia, blepharoptosis and intraocular pressure elevation. CONCLUSIONS: Mixed injections of BoNT-A, triamcinolone acetonide and 5-FU, which compensate the side effects of solitary injection and enhances the anti-fibrotic effect, improves the eyelid position and tear film stability in the patients with GUER. It is an effective and safe method for treating GUER with long maintenance with less adverse effects.
Subject(s)
Humans , Blepharoptosis , Botulinum Toxins, Type A , Diplopia , Eyelids , Fluorouracil , Injections, Intraocular , Intraocular Pressure , Reflex , Retrospective Studies , Tears , Triamcinolone Acetonide , TriamcinoloneABSTRACT
Retinoblastoma (RB) therapy has evolved over decades.In the 1970s, enucleation was important for improving life prognosis.In the 1980s, external beam radiotherapy (EBRT) was popular.In the 1990s, systemic intravenous chemotherapy (IVC) was introduced and currently remains prevalent worldwide for intraocular RB control as well as prevention of systemic metastasis.However, RB seeds in vitreous and subretinal space are still the major obstacles for successful treatments.Advanced ophthalmic imaging technology promotes thorough and detailed description and observation of RB seeds.In the 2000s, interests in periocular chemotherapy (POC), intra-arterial chemotherapy (IAC) and intravitreous chemotherapy (IVitC) have been explored to overcome the low drug concentration around the seeds and to reduce the systemic side effects.This leads us into a new era of target local chemotherapy of RB.How to make the treatment decision based on biological behavior of RB seeds is a major task for us now.
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Objective To study the effect of modified periocular injection on the pains induced by local application of drugs. Methods Sixty patients treated with periocular injection were divided randomly into experimental group and control group in equal number. The control group was treated with orthodox periocular injection,while experimental group with modified periocular injection, immersing the pinhead into lidocaine solution before injection.The pain level of patients was evaluated by self-designed pain scale. Result The pain level of modified periocular injection was lower than that of orthodox periocular injection statistically (Z=3.799, P<0.001).Conclusion Modified periocular injection can alleviate pains induced of local application of drugs obviously and increase their compliance,so it deserves clinically popularizing.
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Background Triamcinolone acetonide (TA) is often used in the treatment of uveitis and fundus disease,but whether it has toxic effect to normal tissue around eyes is unclear.Objective The aim of this study was to explore the adverse and toxic effects of TA on the periorbitally normal tissue following the periocular injection.Methods Twenty-seven New Zealand albino rabbits were randomly divided into experimental group,normal saline solution group and blank control group.TA was periocularly injected twice (20 mg for each) at 1-month interval in the rabbits of the experimental group,and 0.5 ml normal saline solution was used in the same way in the rabbits of the normal saline solution group.Not any drug was used in the blank group.The rabbits were sacrificed 1 month and 2 months,3 months after the secondary injection.For the preparation of the specimens of extraocular muscles,peribulbus adipose tissue,lacrimal gland and optic nerve.Hematoxylin and eosin staining of the specimens was performed to examine the the pathological change under the optical microscope,and the ultrastructural of peribulbus tissues was observed under the transmission electron microscope.Results No statistically significant change was found in IOP among various time points and groups (Fgroup =0.952,P =0.881 ; Ftime =7.297,P =0.411).The hyphological structures and ultrastructure of extraocular muscles,peribulbus adipose tissue,lacrimal gland and optic nerve were normal in the rabbits of the normal saline solution group and the blank control group.However,the optical microscopy showed varying degrees of atrophy or dissolving in the extraocular muscle fibers,the increase of glandular epithelial cells and enlargement of nuclei in the lacrimal gland as well as visible disorder arrangement of nerve fibers,vacuoles degeneration and the decrease of glial cells in optial nerve tissue in the rabbits of the experimental group from 1 month though 3 months after the secondary injection.Under the transmission electron microscope,the muscle stripes,bright band and dark band were incompletely disappeared,and expansionary sarcoplasmic reticulum and oval nucleus at the inferior to sarolemma were seen in the extraocular muscles.In addition,swelling lacrimal gland epithelial cells,thickening nuclear membrane and more organelles were exhibited in the lacrimal gland.In the optic never tissue,uneven myelin,space between axons and myelin,lamellar separation and degeneration also were revealed in the rabbits of the experimental group after injection of TA.Peribulbus adipose tissue was near normal both by optical microscope and transmission electron microscope in the experimental group.Conclusions The periocular injection of TA dose not elevated the IOP.However,it will result in the histogical and ultrastructural damages of extraocular muscles,lacrimal gland and optic nerve.
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PURPOSE: The present study investigated the therapeutic effects of periocular triamcinolone acetonide injections to treat inflammatory signs in patients with severe acute thyroid-associated ophthalmopathy. METHODS: Twenty-two patients with symptoms of severe acute thyroid ophthalmopathy were enrolled in the present study. The patients received four doses of 20 mg of triamcinolone acetonide via periocular injection into the inferotemporal orbital quadrant every 2 weeks. The changes in visual acuity, intraocular pressure, eye ball motility, exophthalmos, thickness of extraocular muscles, clinical activity score and NOSPECS score were measured. RESULTS: Eighteen of 22 patients (81.8%) showed improvement in soft tissue swelling, ten patients (45.5%) showed improvement in conjunctival hyperemia and one patient showed improvement of ocular motility. Clinical activity score and NOSPECS score had significant improvements. No patient had changes in visual acuity, intraocular pressure, diplopia, proptosis or thickness of extraocular muscles. An ocular adverse effect was found in one patient, who had subcutaneous fat atrophy at the injection site. CONCLUSIONS: In patients with severe acute thyroid ophthalmopathy, periocular triamcinolone acetonide injection can be effective to improve acute inflammatory symptoms, without significant adverse effects.
Subject(s)
Humans , Atrophy , Diplopia , Exophthalmos , Eye , Graves Ophthalmopathy , Hyperemia , Injections, Intraocular , Intraocular Pressure , Muscles , Orbit , Subcutaneous Fat , Thyroid Gland , Triamcinolone , Triamcinolone Acetonide , Visual AcuityABSTRACT
Objective To discuss different effect of periocular injection and subconjunctival injection in treatment of iridocyclitis. Methods Eighty people with iridocyclitis were divided into group A and group B according to their admission order. Group A adopted periocular injection and group B was given subconjunctival injection. The incidence of complication was compared between the two groups. Results Significant difference existed in complications and related factors between two groups after treatment, periocular injection proved to be superior to subconjunctival injection. Conclusions Periocular injection is a desirable treatment method for iridocyclitis. It is easy to operate, safe, rapid and with less pain, so it is worthy of clinical application.
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PURPOSE: The aim of this study is to evaluate the effects and complications of periocular injections of triamcinolone acetonide in patients with thyroid orbitopathy who could not tolerate systemic corticosteroid therapy. METHODS: Six patients with a mean age of 48.7 years showed symptoms of severe acute thyroid orbitopathy. They received four doses of 20 mg of triamcinolone acetonide via periocular injection into the inferotemporal orbital quadrant every 2 weeks. The response to treatment and the presence of adverse effects were evaluated retrospectively. RESULTS: Three of six patients (50%) showed significant improvement in soft tissue swelling in both eyes. Only one patient (17%) showed improvement of proptosis. No patients showed improvement in diplopia and ocular motility. The mean thickness of the extraocular muscles measured by CT scan remained unchanged. Compressive optic neuropathy developed in one patient and resolved after intravenous high-dose steroid treatment. Two patients received radiation therapy for resistant inflammatory symptoms. One patient underwent extraocular muscle surgery. In one patient, there was no adverse effect at the injection site, except for a foreign body granuloma. CONCLUSIONS: Periocular triamcinolone injection could be effective for patients with thyroid orbitopathy in the acute inflammatory phase in reducing soft tissue swelling. The procedure showed no significant effect on exophthalmos or ocular motility.