Cost-effectiveness analysis of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in treatment of chronic rhinosinusitis / 中国中药杂志

This study aims to evaluate the effectiveness and economic efficiency of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of chronic rhinosinusitis(CRS). The randomized controlled trial(RCT) of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS was searched against EMbase, PubMed, Cochrane Library, CNKI, VIP, SinoMed, and Wanfang. The efficacy, nasal mucociliary transport time, and safety of the therapy above in the treatment of CRS were analyzed with single-group rate and Meta-analysis, and the economy and sensitivity were evaluated from the perspective of payer. A total of 9 RCTs were included, including 1 145 patients. Meta-analysis showed that compared with Triamcinolone Acetonide Nasal Spray alone, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray in the treatment of CRS patients increased the effective rate(RR=1.17, 95%CI[1.11, 1.24], P<0.000 01) and shortened the nasal mucociliary transport time(MD=-3.32, 95%CI[-5.86,-0.78], P=0.01), there was no significant difference in the incidence of adverse reactions between the two groups. The incremental cost-effectiveness analysis showed that the treatment costs of the control group and the observation group were 44.15 yuan and 1 044.96 yuan, respectively. In the Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray treatment group, 75.48 yuan was spent to improve the effective rate of CRS by 1%. The one-way sensitivity analysis indicated the days of treatment, the RR of Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray, the price of unit preparation of Biyuan Tongqiao Granules, and the effective rate of Triamcinolone Acetonide Nasal Spray alone had great influence on the incremental cost-effectiveness ratio. In conclusion, Biyuan Tongqiao Granules combined with Triamcinolone Acetonide Nasal Spray improves the therapeutic effect on CRS. The probabilistic sensitivity analysis showed that when the willingness to pay was greater than 7 920 yuan(less than 0.1 of GDP per capita 8 098 yuan), the combined therapy was economically superior to the control. Due to the limited number of articles published, it is necessary to carry out a real-world clinical trial of Biyuan Tongqiao Gra-nules and Triamcinolone Acetonide Nasal Spray in the treatment of CRS, so as to compare the cost-effectiveness of Biyuan Tongqiao Granules and Triamcinolone Acetonide Nasal Spray.

Aspirin inhibits the growth of hypertrophic scar in rabbit ears via regulating Wnt/β-catenin signal pathway / 中南大学学报(医学版)

OBJECTIVES@#Steroidal anti-inflammatory drugs have certain side effects in the treatment of hypertrophic scar, and the scar recurrence is easy after withdrawal of steroid anti-inflammatory drugs. Finding reliable alternative drugs is an effective means to improve this defect. Aspirin, a traditional non-steroidal anti-inflammatory drug, is safe for topical use and has anti-inflammatory effects similar to those of steroidal anti-inflammatory drugs, which may have similar effects on the treatment of hypertrophic scar. This study aims to investigate the inhibitory effect of aspirin on the proliferation of hypertrophic scar in rabbit ears and the underlying mechanism.@*METHODS@#The rabbit ear hypertrophic scar models were prepared. The rabbits were randomly divided into a normal skin group (group A), a blank control group (group B), a 0.9% NaCl group (group C), a 0.2% aspirin group (group D), a 0.5% aspirin group (group E), a 2% aspirin group (group F), and a triamcinolone acetonide group (group G). Macroscopic observation of hyperplasia was performed 8 weeks after local injection of the scar, followed by collecting the scar tissue samples for HE staining, Masson staining, and immunohistochemistry, respectively to assess the proliferation of fibroblasts and collagen fibers, and calculate the hypertrophic index, microvessel density, and immunohistochemical score.@*RESULTS@#All rabbit ear hypertrophic scar models were successfully constructed. In groups B and C, the hypertrophic scar edge was irregular, with reddish protruding epidermis, significant contracture and hard touch. In group D, E, and F, with the increase of aspirin administration concentration, the scar became thinner and gradually flat, the proliferation of fibrocytes and collagen fibers was weakened, and the hypertrophic index was gradually decreased (P<0.05). Immunohistochemistry showed that the expression of β-catenin was decreased in the group D, E and F in turn, and the immunohistochemical score was gradually decreased (P<0.05). There was no significant difference in hypertrophic index, microvessel density, and immunohistochemical score (all P>0.05).@*CONCLUSIONS@#Local injection of aspirin can reduce the generation of hypertrophic scar in a dose-dependent manner within a certain concentration range; aspirin inhibits the growth of hypertrophic scar in rabbit ears by inhibiting Wnt/β-catenin signal pathway; 2% aspirin and 40 mg/mL triamcinolone acetonide have similar curative efficacy on hypertrophic scar.

Foliculitis pseudolinfomatosa de McNutt (localización nasal) / McNutt's pseudolymphomatous folliculitis (nasal located)

La foliculitis pseudolinfomatosa, descripta por McNutt en 1986, es una afección de etiología desconocida y poco frecuente, que simula un linfoma cutáneo tanto por su clínica como por su histología. Se presenta como una lesión nodular solitaria, eritematosa, de 0,5 hasta 3cm, de crecimiento rápido, sobre todo en la cara, en personas de 40 a 60 años, con una histopatología caracterizada por un infiltrado linfocitario B yT perifocular, y células dendríticas positivas en la inmunohistoquímica para S100yCD1a. Su curso es benigno, muchas veces autolimitado. Se expone el caso de una paciente con una particular forma clínica de pseudolinforma.

Pseudolymphomatous folliculitis, described by McNutt in 1986, is a non-frequent entity of unknown etiology that simulates a cutaneous lymphoma, both clinically and histologically. It shows as a solitary erythematous nodular lesion of 0.5 to 3 cm, with a rapid growth, mainly on the face, in people aged 40 to 60 years, and histopathology characterized by a perifollicular B and T lymphocytic infiltrate, and positive dendritic cells for immunohistochemistry S100 and CD1a. Its course is benign, often self-limited. The case of a patient with a particular clinical form of pseudolymphoma is presented.

Use of hyaluronic acid associated with triamcinolone acetonide or ozone gas in the treatment of induced osteoarthritis in rabbits

Purpose: To evaluate the effects of the intra-articular application of hyaluronic acid associated with triamcinolone acetonide, and ozone gas in the treatment of induced osteoarthritis in rabbit’s stifles.Methods: Twenty-one Norfolk rabbits were submitted to cranial cruciate ligament transection of the left stifle. After six weeks of the surgery, the rabbits were randomized assigned into three groups: G1 (control) – saline solution (0.9%); G2 – hyaluronic acid associated with triamcinolone; G3 – ozone gas, submitted to three intra-articular applications every seven days. Results: Significant differences occurred: osteophytes at medial femoral condyle (G2 > G1, G2 > G3) on radiography exam; thickening of the medial condyle (G1 > G3, G2 > G3) on ultrasound exam; osteophytes at lateral tibial condyle (G2 > G1, G2 > G3), and medial femoral condyle (G1 > G2, G3 > G1) on computed tomography. Histologically, mean values of chondrocytes in the femur and tibia in G3 and G2 were statistically lower. Conclusions: The intra-articular injection of hyaluronic acid associated with triamcinolone accentuated degenerative joint disease by imaging and macroscopic evaluations, and by histological findings, this treatment and the ozone gas treatment showed similar effects and were inferior to the saline solution (0.9%).

Cystoid macular edema secondary to intraocular lens sub-luxation and iris perforation by iol haptic / Edema macular cistóide secundário a subluxação de lente intraocular e perfuração da íris por haptico da lente

Abstract We present a case of 50-years-old, man with vision loss, dysmorphopsia and micropsy in the right eye with for 6 months. Ocular history included uncomplicated cataract surgery 10 years before. Best corrected visual acuity was 20/100 in the right eye and 20/20 in the left eye. Anterior segment OD demonstrated intra-ocular lens (IOL) haptic in the anterior chamber with iris perforation. Fundus examination revealed cystoid macular edema in right eye. Surgical approach with reposition of the IOL and triamcinolone acetonide intravitreal injection were performed with visual and tomographical improvement.

Resumo Apresentamos o caso de um homem de 50 anos, com queixa de perda de visão, dismorfopsia e micropsia em olho direito (OD) há 6 meses. A história ocular incluiu cirurgia de catarata sem complicações 10 anos antes. A melhor acuidade visual corrigida foi 20/100 em OD e 20/20 em olho esquerdo. O segment anterior do OD demonstrou háptica da lente intraocular (LIO) na câmara anterior com perfuração da íris. A fundoscopia revelou edema macular cistoide em OD. A abordagem cirúrgica com reposição da LIO e injeção intravítrea de triancinolona acetonida foi realizada com melhora visual e tomográfica.

Cicatriz queloide gigante / Giant keloid scar

Introducción: La cicatriz queloide forma parte de las cicatrices patológicas por exceso; es una afección que se caracteriza por el depósito excesivo de colágeno en la dermis y tejido celular subcutáneo. El proceso por el cual se desarrolla no es del todo conocido, es más frecuente en la raza negra y afecta en igual proporción a hombres que mujeres. Objetivo: Informar a la comunidad médica sobre experiencia en el manejo y tratamiento con dos pacientes portadores de lesiones queloides de gran tamaño. Caso clínico: Se presentan dos pacientes con cicatriz queloide gigante a partir de ambos lóbulos auriculares y cuello anterior; se expone la conducta terapéutica basada en la combinación de tres modalidades de tratamiento: cirugía; infiltración con acetónido de triamcinolona, 1 ml (40 mg) desde el día del acto quirúrgico, se repitió cada 15 días; junto a presoterapia con crema esteroidea. Conclusiones: Aunque no existe un tratamiento ideal, se debe tener en cuenta al tratar esta enfermedad si se está ante una lesión recidivante, el tiempo de aparición de la tumoración, sus características clínicas; de seleccionarse el tratamiento quirúrgico como opción terapéutica, debe acompañarse de otras modalidades de tratamiento(AU)

Introduction: The keloid scar is part of the pathological scars by excess, is a condition characterized by the excessive deposit of collagen in the dermis and subcutaneous cell tissue, the process by which it develops is not entirely known, it is more frequent in the black race, affects in equal proportion men than women. Objective: To inform the medical community of the experience in handling and treating two patients with large keloid lesions. Clinical case: Two patients with giant keloid scars are presented from both earlobes and anterior neck where therapeutic behavior based on the combination of three treatment modalities is exposed: surgery, triamcinolone acetonide 1 ml (40mg) infiltration beginning on the first day after surgery, repeated every 15 days and pressotherapy with steroid cream. Conclusions: Although there is no ideal treatment, it should be taken into account when treating this disease if we are facing a recurrent injury, the time of onset of the tumor, its clinical characteristics, surgical treatment should be selected as a therapeutic option, accompanied by other forms of treatment(AU)

A double-blind, randomized controlled trial on the efficacy and safety of 4% niacinamide cream on the treatment of mild to moderate chronic plaque psoriasis at the University of Santo Tomas Hospital Out-Patient Department

@#Background: Niacinamide is known for its anti-inflammatory effect and skin penetration capability. Currently, limited studies are available on its efficacy on psoriasis. Objective: This study aimed to determine the efficacy and safety of 4% niacinamide cream on mild to moderate psoriasis. Methods: 40 patients were randomly allocated to 4% niacinamide cream (N), or 0.1% triamcinolone acetonide cream (TAC) or 4% niacinamide cream and 0.1% triamcinolone acetonide cream (N-TAC) for 10 weeks treatment. A 50% improvement in psoriasis area severity index (PASI50) was considered as the primary endpoint of the study. Secondary outcome measures were physician global assessment (PGA), dermatology life quality index (DLQI), and adverse events. PASI and PGA were assessed biweekly. DLQI was assessed at the start and at the end of the study period. Results: PASI50 was achieved in 85% of patients in N-TAC, 75% of patients in TAC and 15% of patients in N. There was no statistical significant difference between groups TAC and N-TAC (p=0.645, Fisher’s exact test). A higher number of patients in N-TAC (31%) achieved PGA1 score or “almost clear” and reached PASI50 earlier (60% at week 4). A higher improvement in DLQI score was seen in N-TAC; however, mean DLQI improvement did not vary by treatment group (p=0.0770). No adverse event was reported for groups TAC and N-TAC while pruritus and erythema were noted in N. Conclusion: Monotherapy of 4% niacinamide cream was not effective in the treatment of mild to moderate psoriasis. The combination N-TAC showed a continuous and sustained improvement of lesions compared to monotherapy TAC.

Soaking oro-pharyngeal pack with triamcinolone acetonide lowers discomfort in functional endoscopic sinus surgeries / Pack orofaringeo con triamcinolone disminuye molestias luego de cirugía endoscópica sinusal

BACKGROUND: Postoperative sore throat (POST) is defined as pain or discomfort in the throat following general anesthesia. Throat packs are used by many surgical subspecialties for different benifits, however they may increase the incidence of POST. Many interventions can be used to decrease incidence of POST. Triamcinolone acetonide (TA) is a moderately potent topical corticosteroid preparation. In this study, we hypothesized that soaking the throat pack with TA may decrease POST. METHODS AND MATERIAL: This prospective interventional comparative study was performed on 54 patients planned for Functional Endoscopic Sinus Surgeries (FEES) surgery. After endotracheal intubation, a standard length of oro-pharyngeal pack was placed, then patients were randomly allocated into: Group I: Oro-pharyngeal packs were soaked with 15 mg Triamcinolone acetonide 0.1% and Group II: packs were soaked with the same volume of lubricating gel (K-Y gel®). The patients were postoperatively asked about: sore throat, dysphagia, hoarseness of voice and nausea and vomiting. RESULTS: Thirty minutes and 24 hours after extubation, Group I patients showed lower but statistically insignificant sore throat scores. Two to six hours after extubation, Group I showed a statistically significant reduction in sore throat scores. Six patients suffered dysphagia in group I compared with 8 patients in group II. Hoarseness of voice occurred in 1 patient in group I and 3 patients in group II. No patient complained of nausea or vomiting. cONCLUSIÓN: Soaking oropharyngeal pack with triamcinolone acetonide in orabase gel was able to decrease POST in FESS patients.

Intravitreal and posterior subtenon triamcinolone acetonide for severe acute posterior multifocal placoid pigment epitheliopathy / Triancinolona intravítrea e sub-tenoniana para epiteliopatia pigmentar placóide multifocal posterior aguda grave

ABSTRACT A 21-year-old man presented with visual acuity of 20/200 in both eyes. The fundus picture, fluorescein angiography, and optical coherence tomography revealed severe bilateral acute posterior multifocal placoid pigment epitheliopathy and serous macular detachments. We treated the patient with triamcinolone acetonide, an intravitreal injection (4 mg/0.1 mL) in one eye and a posterior subtenon injection (40 mg/1 mL) in the other eye. Within 2 weeks the visual acuity was 20/80 in both eyes. At the 8-week follow-up visit his vision was 20/63 bilaterally. One year later the vision remained 20/63 in both eyes. In this patient, the triamcinolone acetonide injections, whether administered intravitreally or via the posterior subtenon route, achieved similar anatomic and functional recovery results.

RESUMO Um homem de 21 anos apresentou acuidade visual de 20/200 em ambos os olhos. O quadro de fundo de olho, angiofluoresceinografia e a tomografia de coerência óptica revelaram epiteliopatia pigmentar placóide multifocal posterior aguda e descolamento macular seroso. Tratamos o paciente com triancinolona acetonida, uma injeção intravítrea (4 mg/0,1 ml) em um olho e uma injeção subtenoniana posterior (40 mg/1 ml) no outro olho. Após 2 semanas, a acuidade visual foi de 20/80 em ambos os olhos. Na visita de acompanhamento de 8 semanas, sua visão foi de 20/63 bilateralmente. Um ano depois, a visão permaneceu 20/63 em ambos os olhos. Neste paciente, as injeções de triancinolona, administradas por via intravítrea ou por via subtenoniana posterior, obtiveram resultados semelhantes na recuperação anatômica e funcional.

Triamcinolone Acetonide Injections for Lateral Malleolar Bursitis of the Ankle / 대한족부족관절학회지

PURPOSE: This study examined the clinical outcomes and usefulness of triamcinolone acetonide (TA) injections as an option in the conservative treatment of patients with lateral malleolar bursitis of the ankle. MATERIALS AND METHODS: A total of 27 patients (27 ankles), in whom TA injection had been performed between March 2016 and June 2017, were reviewed retrospectively. After the aspiration of fluid in the lateral malleolar bursal sac, 1 mL (40 mg) of TA was injected into the malleolar bursal sac. After the injection, the ankle was compressed with an elastic cohesive bandage for 2 to 4 weeks. The clinical outcomes and side effects were evaluated at the following time points: 2 weeks, 4 weeks, 3 months, 6 months, and 1 year after TA injection therapy. The responses to treatment were assessed according to the degree of fluctuation, shrinkage of the bursal sac, and soft tissue swelling. RESULTS: The mean age was 62.1 years (range, 41~81 years); there were 19 males and 8 females. Complete resolution was observed in 26 patients (96.3%) after the first or second application of a TA injection, and a partial response was observed in 1 patient (3.7%) after the first TA injection. The physical component scores of Medical Outcomes Study 36-item Short-Form Health Survey improved from 71.1 to 76.0 at the last follow-up (p=0.001). Associated complications were 1 patient (3.7%) with skin atrophy and 3 patients (11.1%) with transient hyperglycemia in diabetes mellitus. CONCLUSION: TA injection is a useful and safe procedure for patients not responding to the usual conservative treatment of lateral malleolar bursitis of the ankle.

Treatment of post-traumatic chin deformities using bilateral botulinum toxin injections

Post-traumatic hematoma formation is a common complication of contusion. If the hematoma is large enough to aspirate or drain, it can be treated quickly and appropriately. However, if the hematoma is small or concealed by local swelling, it may be overlooked and left untreated. In most cases, a hematoma will resolve following conservative treatment; however, associated infection or muscle fibrosis can occur. Herein, we present the case of a patient with a chin deformity caused by a post-traumatic hematoma. The deformity was treated using botulinum toxin and triamcinolone acetonide injections as minimally invasive treatments. The course of treatment was good.

Efficacy for combined injection of salvizanolic acid B with triamcinolone acetonide on the treatment of the soft palate with oral submucous fibrosis / 中南大学学报(医学版)

To evaluate therapeutic effect of combined injection of salvizanolic acid B with triamcinolone acetonide on the treatment of the soft palate with oral submucous fibrosis.
 Methods: Salvizanolic acid B combined with triamcinolone acetonide was consecutively applied once a week for 30 weeks for 33 patients with middle and later periods of oral submucous fibrosis. The response rate of color change in the soft palate and the increase of capillary vessels (determined by degree I-IV visual analog scale) were evaluated at the 12th, 24th, and 36th months after 30 weeks treatment.
 Results: Thirty-three patients were fulfilled the study without obvious adverse reactions and they were followed up for 24 months, while 31 patients were followed up for 36 months. The color change in the soft palatal mucus and the increase of capillary vessels at the 36th month follow-up after treatment were significantly better than those at the 12th month (P=0.004).
 Conclusion: Combined injection of salvizanolic acid B with triamcinolone acetonide in the treatment of the soft palate with oral submucous fibrosis is effective.

Hyaluronic acid has chondroprotective and joint-preserving effects on LPS-induced synovitis in horses

The intra-articular use of hyaluronic acid (HA) for the treatment of synovitis and osteoarthritis is still controversial. As a consequence, corticosteroids remain the most frequently employed therapeutic agents, despite their potential systemic and local deleterious effects. This study examined the anti-inflammatory, antioxidant, and chondroprotective activities of low and high molecular weight hyaluronic acid (LMW-HA and HMW-HA) on lipopolysaccharide (LPS)-induced synovitis in horses compared to triamcinolone acetonide (TA). LPS was injected in the metacarpophalangeal joints, which were treated intra-articularly with either TA (as control) or LMW-HA or HMW-HA. Joint clinical evaluation and synovial fluid (SF) analysis were performed at 0, 8, 24, and 48 h. The white blood cell counts (WBC), prostaglandin E2 (PGE2), interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-α, chondroitin sulfate (CS) and HA concentrations, oxidative burst, and HA molecular weights were measured. TA reduced the lameness, swelling, and PGE2 release but increased the SF CS concentrations enormously at 24h and 48h, and decreased the SF HA modal molecular weight. These results indicate the breakdown of articular cartilage aggrecan and SF HA. In contrast, LMW-HA and HMW-HA were less effective in reducing the inflammation symptoms, but preserved the joints because only a modest increase in CS occurred at 24 h, decreasing at 48 h, and the SF HA was maintained. The HA-treatment also had anti-inflammatory actions, and LMW-HA was the most effective in reducing the release of cytokine. In summary, the HA treatment inhibited efficiently the digestion of cartilage proteoglycans and SF HA breakdown.

Oftalmia simpática / Sympathetic ophthalmia

Resumo Relatar um caso de um paciente portador de Oftalmia Simpática (OS), com descolamento seroso da retina documentado através de tomografia de coerência óptica de domínio spectral (SD OCT), indocianina verde (ICG) e angiofluoreceinografia (AGF), que o diagnóstico foi realizado em uma consulta de rotina e iniciado tratamento clínico .

Abstract To report the case of a patient with sympathetic ophthalmia (OS), with serous detachment of retinal documented by spectral domain optical coherence tomography (OCT), indocyanine green (ICG) and angiofluorecephography (AGF). The diagnosis was made in a routine consultation and clinical treatment was initiated.

Effects of sub-Tenon's triamcinolone injections in patients with uveitis / Efeitos da injeção subtenoniana de triancionolona em pacientes com uveítes

ABSTRACT Purpose: To evaluate the response to sub-Tenon's triamcinolone injection in patients with uveitis. Methods: We studied 28 eyes with macular edema associated with controlled uveitis. We administered sub-Tenon's injection of triamcinolone and followed the patients for 180 days to analyze the positive effects (improvement of macular edema and visual acuity) and monitor the possible adverse effects. This prospective study was conducted at the Department of Ophthalmology, Hospital de Clínicas de Porto Alegre, Brazil. Results: We observed improvement in macular edema in 86% of patients. The mean central macular thickness at each time point of assessment was 432.22, 298.80, 286.37, 267.49, 253.87, and 253.49 mm at baseline (before sub-Tenon's injection of triamcinolone), 15 days after the procedure, at 30 days, at 60 days, at 90 days, and at 180 days, respectively. The mean reduction in retinal thickness was 30.8%, 33.7%, 38.11%, 41.2%, and 41.35% at 15, 30, 60, 90, and 180 days of follow-up, respectively. Visual acuity also improved in 85.7% of patients, with a mean improvement of 1.36, 1.93, 2.23, 2.26, and 2.30 lines gained on the Early Treatment Diabetic Retinopathy Study chart at 15, 30, 60, 90, and 180 days of follow-up, respectively. No statistically significant increases in intraocular pressure and conjunctival abnormalities were caused by the procedure, and no other adverse effects were observed. Overall, the results of this study were similar to those described in the literature. Conclusions: Sub-Tenon's injection of triamcinolone provides reduced macular thickness and improvement in visual acuity with no significant adverse effects and is therefore an effective and safe procedure for the treatment of sequelae of uveitis.

RESUMO Objetivos: Avaliar os efeitos da injeção subtenoniana de triancinolona em pacientes com uveítes. Métodos: Foram incluídos na avaliação 28 olhos com edema macular associado à uveíte. Esses pacientes foram submetidos à injeção subtenoniana de triancinolona e acompanhados ao longo de 180 dias, para analisar os efeitos em relação à melhora do edema macular, da acuidade visual e acompanhamento de possíveis efeitos adversos. Trata-se de um estudo prospectivo, realizado no Serviço de Oftalmologia do Hospital de Clínicas de Porto Alegre. Resultados: Foi verificada melhora do edema macular em 86% dos pacientes, sendo uma redução média da espessura retiniana de 30,8% aos 15 dias, 33,7% aos 30 dias, 38,11% aos 60 dias, 41,2% aos 90 dias e 41,35% aos 180 dias de seguimento. Também foi observado melhora da acuidade visual em 85,7% dos pacientes e ganho de linhas na tabela de acuidade visual, sendo 1,36 linhas aos 15 dias de seguimento, 1,93 linhas aos 30 dias, 2,23 linhas aos 60 dias, 2,26 linhas aos 90 dias e 2,30 linhas aos 180 dias. Não houve significância estatística em relação ao aumento da pressão intraocular e às alterações conjuntivais causadas pelo procedimento, sem detecção de qualquer outro efeito colateral. Foi concluído que os resultados encontrados nesse estudo são similares aos descritos na literatura. Conclusões: A injeção subtenoniana de triancinolona é um procedimento eficaz e seguro para o tratamento das sequelas por quadros de uveítes, proporcionando redução da espessura macular e melhora da acuidade visual, sem relação com efeitos adversos significativos.

Study of structural changes in diabetic macular edema by spectral domain optical coherent tomography after intravitreal injection of triamcinolone acetonide

Purpose: is to study the morphological changes in Diabetic Macular Edema [DME] before and after intravitreal injection of triamcinolone acetonide using the spectral domain-optical coherence tomography [SD-OCT] parameters

Patient and methods: The study was held at Al-Zahraa University Hospital. It included 49 eyes of 40 patients with clinically significant diabetic macular edema [CSDME]. A single intravitreal injection of triamcinolone acetonide [IVTA] at the dose of 4 mg in 0.1 ml was administered. Best corrected visual acuity [BCVA], intraocular pressure [IOP] and OCT scanning of the macula were done before and 3 months after IVTA. The OCT study parameters included central foveal thickness [CFT], OCT pattern of DME, vitreomacular interface [VMI], presence or absence of serous macular detachment [SMD], hard exudates [HEs], hyper-reflective spots [HRS] and IS/OS junction [Foveal ellipsoid zone] and ELM integrity

Results: Mean BCVA +/- SD were [0.23 +/- 0.13] and [0.39 +/- 0.22] pre and 3 months after IVTA respectively. The initial mean CFT +/- SD was [424 +/- 127.1 um] while 3 months after IVTAit was [283.1 +/- 70.2 um]. Eighteen eyes showed SMD which was completely absent 3 months after a single IVTA. There was insignificant statistical difference of the VMI state before and 3 months after IVTA. Out of thirty-four eyes that showed the presence of HEs in this study, twenty-seven eyes showed diminution of these HEs size 3 months after injection. Forty-one eyes and forty-three eyes showed the presence of HRS before and after IVTA respectively. There was insignificant statistical difference in foveal ellipsoid zone and ELM integrity before and 3 months after IVTA. Complications were reported in 16 eyes [32.6%]. Cataract progression was noted in 6 eyes [12.2 %]. Steroid induced IOP elevation was reported in 10 eyes [20.4%]

Conclusions: The data collected from OCT macular B scan are effective in the prognosis and follow up of diabetic macular edema. IVTA remains a promising primary therapy for DME at least in short terms. It seems relatively safe, but not without complications

Evaluation of Triamcinolone Injection and Subcision as a First-Line Non-Surgical Treatment of Post-Traumatic Acute Trap-Door Deformity

BACKGROUND: Trap-door deformity is a biophysical phenomenon in which U-, C-, or V-shaped linear scars tend to become depressed and the tissue circumscribed by them tends to bulge. The aim of the present study was to demonstrate the efficacy of triamcinolone acetonide (TCA) injection and subcision as a first-line treatment for post-traumatic acute trap-door deformity. METHODS: In trap-door deformity patients, a subcision was made by cutting the fibrotic band along the scar line in the depression using a 22-gauge needle. TCA was administered. An intralesional injection was made along areas of scarring that were difficult to penetrate with the needle. Scar quality parameters were assessed at each follow-up by a single observer and the patient, using the patient and observer scar assessment scale (POSAS) with an additional question about bulging. RESULTS: The average POSAS score per question on the observer scale improved from 6.6±1.31 to 3.6±1.08, and the average POSAS score per question on the patient scale improved from 5.5±1.57 to 2.5±1.26. The average bulging score on the observer scale decreased from 6.0±0.98 to 3.0±0.83, and that on the patient scale decreased from 5.0±1.67 to 2.0±1.30. The average general opinion score on the observer scale decreased from 5.5±1.12 to 3.5±0.91, and that on the patient scale decreased from 6.0±1.84 to 2.0±0.79. CONCLUSIONS: Better outcomes can be obtained by using both TCA and subcision as the first-line therapy for post-traumatic acute trap-door deformity.

Supratarsal injection of triamcinolone for severe vernal keratoconjunctivitis in children / Injeção supratarsal de triancinolona na ceratoconjuntivite primaveril grave em crianças

ABSTRACT Purpose: To evaluate the use of supratarsal injection of triamcinolone acetonide in severe vernal keratoconjunctivitis (VKC) in children. Methods: Patients included in this open clinical trial were those with severe VKC-associated with keratitis, gelatinous limbal infiltrates, and/or giant papillae, with a history of recurrence and resistance to conventional topical antiallergic agents. Patients were treated with a supratarsal injection of 20 mg triamcinolone acetonide. Results: Analysis included 27 injections in 23 eyes of 17 patients with severe allergic keratoconjunctivitis. Mean age was 12.3 (range: 7-19) years. Mean follow-up time was 39.3 months (SD=19.21). In the 17 patients, the disease was successfully controlled for an average of 3.6 months (range: 1-16), during which allergy symptoms and signs were significantly improved, with complete resolution of lid edema and conjunctival chemosis, significant decline of pannus and keratitis, and reduction of giant papillae size. Conclusion: Treatment of severe, acute VKC in children with supratarsal injection of 20 mg triamcinolone acetonide showed satisfactory results and was well tolerated by patients; it may therefore constitute a safe option for severe and challenging cases. While full disease remission was not achieved, a significant improvement was found in ocular allergy symptoms and signs, with a reduction in the frequency of acute recurrences.

RESUMO Objetivo: Avaliar o uso da injeção supratarsal de triancinolona na ceratocon junti vite primaveril grave (VKC) em crianças. Métodos: Pacientes com VKC grave associada à ceratite, limbo gelatinoso e/ou papilas gigantes, com história de recidivas e resistência a agentes antialérgicos tópicos convencionais foram incluídos neste ensaio clínico. Os pacientes foram tratados com injeção de 20 mg de acetato de triancinolona supratarsal. Resultados: A análise incluiu 23 olhos de 17 pacientes com ceratoconjuntivite alérgica grave. A idade média foi de 12,3 com intervalo de 7-19 anos. O tempo médio de acompanhamento foi de 39,3 meses (DP 19,21). Dos 17 pacientes, a doença foi controlada com sucesso por uma média de 3,6 meses (intervalo 1-16) em que os sinais e sintomas foram significativamente melhorados com resolução completa do edema palpebral e quemose conjuntival, redução significativa de pannus, ceratite e redução do tamanho das papilas gigantes. Conclusão: O tratamento da VKC grave em crianças com injeção supratarsal de 20 mg de acetato de triancinolona mostrou resultados satisfatórios, sendo bem tolerada pelas crianças às quais foram submetidas, podendo constituir uma opção segura para casos graves e difíceis de VKC. Uma melhora significativa foi encontrada nos sinais e sintomas alérgicos oculares, com diminuição da frequência de recidivas agudas, no entanto sem se mostrar efetiva para a completa remissão da doença.

Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion / Incidência de neovasos de segmento anterior durante o tratamento de edema macular secundário a oclusão da veia central da retina

ABSTRACT Purpose: To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). Methods: In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. Results: ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Conclusion: Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

RESUMO Objetivo: Analisar as taxas de incidência de neovascularização do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundário a oclusão de veia central da retina (OVCR), em tratamento com injeções intravítreas de triamcinolona (IVTA) ou bevacizumab (IVB). Métodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundário a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primário foi a taxa de incidência de NSA no mês 6. Os desfechos secundários foram alterações médias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerência óptica, até o mês 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e três (37,50%) olhos no grupo tratado com injeções intravítreas de Triamcinolona, Não houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferença estatisticamente significante (p<0,05) entre os grupos, somente no mês 1. A EFC não apresentou diferenças estatisticamente significantes (p<0,05) entre os grupos ao longo dos 12 meses. GNV ocorreu em um olho apesar do tratamento com laser e este paciente necessitou de intervenção cirúrgica. Conclusão: O tratamento precoce com injeções intravítreas de Anti VEGF podem diminuir as taxas de neovascularização do segmento anterior e glaucoma neovascular após oclusão de veia central da retina.