Intraoperative intravitreal injection of triamcinolone acetonide for cataract extraction in patients with uveitis.

PURPOSE: To evaluate the efficacy of intravitreal triamcinolone injection in controlling postoperative inflammation after cataract extraction in patients with uveitis. METHODS: This retrospective study included 30 eyes with uveitis that had phacoemulsification or extracapsular cataract extraction with intraocular lens implantation. Intravitreal triamcinolone acetonide (4 mg) was injected at the end of surgery. No systemic steroids were given after surgery. RESULTS: Visual acuity improvement of 2 lines or more occurred in 26 eyes (86.7%). Six eyes (20%) had a best-corrected visual acuity of 6/60 or better before surgery, which increased to 22 eyes (73.3%) after surgery. Five eyes (16.7%) had a visual acuity of 6/12 or better after surgery. Intravitreal triamcinolone injection controlled the postoperative inflammation in all eyes for at least 3 months following surgery. CONCLUSION: Intravitreal triamcinolone injection was effective in controlling postoperative inflammation after cataract extraction in patients with uveitis sparing the use of systemic steroids.

Hyposensitization in the treatment of resistant cases of vernal keratoconjunctivitis.

PURPOSE: The study evaluated the treatment of resistant cases of vernal keratoconjunctivitis by hyposensitization resulting from intradermal skin reactions of different allergens. METHODS: This prospective study was carried out in the Department of Ophthalmology and the Department of Microbiology and Immunology, Zagazig University, and included 36 patients with bilateral vernal keratoconjunctivitis that was resistant to topical corticosteroids and antihistaminic drugs. Patients were subjected to intradermal skin reactions to different allergens after stoppage of the medication. Subcutaneous injections of different allergens were administered in addition to topical vasoconstrictor and antihistaminic eye drops for different durations of 12, 18, and 24 months. RESULTS: The study revealed that most of the patients were sensitive to pollens (65%), house dust (55%), and tobacco smoke (40%). Among 36 total patients who received different doses of allergens, 10 of 20 patients showed marked improvement following a 24-month treatment period, with a 50% success rate. Another 3 of 9 patients showed marked improvement following an 18-month treatment period, with a 33.3% success rate. CONCLUSION: The use of intradermal skin reactions to determine the sensitivity for different stimulating allergens in resistant cases of vernal keratoconjunctivitis was conclusive. Treatment by hyposensitization using prepared vaccines had an acceptable success rate especially in patients treated for 24 months. Future studies will be needed to determine how effective this treatment is with other allergens and for longer durations of hyposensitization. Additional immunologic studies will be essential for developing a strategy of management of resistance in such cases of resistant vernal keratoconjunctivitis.

Orbital steroid injection versus oral steroid therapy in management of thyroid-related ophthalmopathy.

BACKGROUND: The aim of this study was to evaluate the efficacy, safety and complications of orbital steroid injection versus oral steroid therapy in the management of thyroid-related ophthalmopathy. METHODS: A total of 29 patients suffering from thyroid ophthalmopathy were included in this study. Patients were randomized into two groups: group I included 15 patients treated with oral prednisolone and group II included 14 patients treated with peribulbar triamcinolone orbital injection. Only 12 patients in both groups (16 female and 8 male) completed the study. RESULTS: Both groups showed improvement in symptoms and in clinical evidence of inflammation with improvement of eye movement and proptosis in most cases. Mean exophthalmometry value before treatment was 22.6 ± 1.98 mm that decreased to 18.6 ± 0.996 mm in group I, compared with 23 ± 1.86 mm that decreased to 19.08 ± 1.16 mm in group II. Mean initial clinical activity score was 4.75 ± 1.2 and 5 ± 1.3 for group I and group II before treatment, respectively, which dropped to 0.83 ± 1.2 and 0.83 ± 1.02, 6 months after treatment, respectively. There was no change in the best-corrected visual acuity in both groups. There was an increase in body weight, blood sugar, blood pressure and gastritis in group I in 66.7%, 33.3%, 50% and 75%, respectively, compared with 0%, 0%, 8.3% and 8.3% in group II. No adverse local side effects were observed in group II. CONCLUSION: Orbital steroid injection for thyroid-related ophthalmopathy is effective and safe. It eliminates the adverse reactions associated with oral corticosteroid use.

Management of neovascular glaucoma with panretinal photocoagulation, intravitreal bevacizumab, and subsequent trabeculectomy with mitomycin C.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of using intravitreal bevacizumab, panretinal photocoagulation, and trabeculectomy with mitomycin C in the management of neovascular glaucoma. PATIENTS AND METHODS: The study included 17 eyes of 15 patients with neovascular glaucoma. Panretinal photocoagulation was performed combined with intravitreal bevacizumab injection (1.25 mg in 0.05 mL). A fornix-based conjunctival flap trabeculectomy with intraoperative mitomycin C (0.4mg/mL for 3min) was then performed. RESULTS: The causes of neovascular glaucoma included: diabetic retinopathy (10 eyes), central retinal vein occlusion (5 eyes), and branch retinal vein occlusion (2 eyes). Complete regression of iris neovascularization after intravitreal bevacizumab injection and panretinal photocoagulation occurred in 14 eyes (82.4%). After trabeculectomy with mitomycin C, mean intraocular pressure was reduced from 42.9±4.2 mm Hg preoperatively to 15.1±2.2, 16.3±2.0, and 19.7±2.1 mm Hg at first week, first month, and sixth months postoperatively, respectively. This reduction was statistically significant (P<0.05). The mean number of antiglaucoma medications used before surgery was 2.8±0.4 (range: 2 to 3) that decreased to 0.8±0.6 (range: 0 to 3) after surgery. Postoperative hypotony (intraocular pressure 7 mm Hg) was observed in 17.6% (3 of 17 eyes), conjunctival dehiscence in 5.9%, shallow anterior chamber in 11.8%, hyphema in 23.5%, choroidal detachment in 11.8%, and epithelial corneal erosions related to applications of mitomycin C in 1 eye (5.9%). CONCLUSIONS: Trabeculectomy with intraoperative mitomycin C after an adjunctive treatment with intravitreal bevacizumab and panretinal photocoagulation is a good treatment modality in the management of eyes with neovascular glaucoma.