Suprachoroidal triamcinolone versus posterior subtenon triamcinolone either alone or formulated in the management of diabetic macular edema.

PURPOSE: This study aims to compare posterior subtenon triamcinolone acetonide injection either formulated or alone versus suprachoroidal triamcinolone in the management of diabetic macular edema. METHODS: This study is a prospective interventional study that included 75 patients, divided into three groups, each group with 25 patients. Group I received a combination of triamcinolone acetonide (TA) (40 mg) and VISCOAT, which is a combination of sodium chondroitin sulfate (20 mg) and sodium hyaluronate (15 mg). The injection was done in the posterior subtenon space using the NAGATA cannula. Group II received TA (40 mg) in the posterior subtenon space. Group III underwent an injection of 4 mg/100µl of TA in the supra choroidal space. RESULTS: We found a statistically significant difference between the three studied groups regarding BCVA (P = 0.001) and CMT at six months postoperative (P = 0.001) with the highest median BCVA and lowest median CMT observed in the formulated TA group. CONCLUSION: We concluded that early treatment of DME by formulated TA is better than TA alone, and suprachoroidal TA in the form of increasing the BCVA and decreasing the CMT without any elevation of IOP. Trial registration number NCT05464953. Date of registration 17/7/2022 (retrospectively registered).

Response to treatment with intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligo articular juvenile idiopathic arthritis.

BACKGROUND: Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection. METHODS: Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children's Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA. RESULTS: Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted. CONCLUSION: Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.

Improved release of triamcinolone acetonide from medicated soft contact lenses loaded with drug nanosuspensions.

Drug nanosuspensions (NSs) show a significant potential to improve loading and release properties of the poorly water soluble drug triamcinolone acetonide (TA) from poly(hydroxyethyl methacrylate) (pHEMA) soft contact lenses. In this work, TA NSs were developed by a controlled precipitation method using a fractional factorial Plackett-Burmann design. Poloxamer 407 (PL) and polyvinyl alcohol (PVA) as stabilizing agents were selected. NSs were characterized in terms of their drug content, particle size and morphology. Results indicate that all studied factors, except homogenization speed and sonication, have significant influence on the drug incorporation yield into NSs. Drug nanoparticles showed an interesting size that may be suitable for their incorporation into topical ocular drug delivery systems, as hydrogels. pHEMA hydrogels and daily-wear Hilafilcon B commercial contact lenses (SCLs) were employed to study TA loading capacity and drug release properties using NSs as loading system. Hydrogels have been synthesised by copolymerization of 2-hydroxyethyl methacrylate (HEMA) with methacrylic acid (MA) in accordance with a previous work (García-Millán et al., 2015). Both synthesised hydrogels and SCLs were characterized in terms of their mechanical and physical properties and TA loading and release properties. Selected TA NS was further characterized by studying its physical-chemical stability during the loading process. Results show that the use of TA NSs as loading medium significantly increases drug loading capacity and release of soft contact lenses in comparison with drug saturated solution. Synthesised pHEMA hydrogels and SCLs lenses have good properties as ophthalmic drug delivery systems, but SCLs load higher quantities of drug and release TA in shorter time periods than synthesised pHEMA hydrogel.

Role of posterior sub-tenon triamcinolone acetonide in patients of refractory macular oedema.

OBJECTIVE: To evaluate the results of posterior sub-tenon triamcinolone acetonide in patients of refractory macular oedema suffering with retinal vascular disorders. METHODS: This quasi-experimental study was conducted at Layton Rahmatulla Benevolent Trust, Lahore, Pakistan, from October 2014 to March 2015, and comprised eyes of patients with refractory macular oedema. The central macular thickness of all patients was determined with ocular coherence tomography before giving injection of 40mg/ml posterior sub-tenon triamcinolone acetonide. After the injection, central macular thickness of each eye was measured in follow-ups at 1st week, 1st month and 2nd month with ocular coherence tomography. RESULTS: Of the 40 participants, 26(65%) were men and 14(35%) women. The mean age was 61.80±7.20 years. The mean central macular thickness before injection was 488.70±34.93, while it was 337.60±146 after 1st week of injection, 420.60 ± 76.13 after 1st month and 477.98±72.30 after two months. Comparisons of central macular thickness at various follow-ups showed a significant difference from the baseline to the last follow-up (p<0.001). Moreover, 4(14%) subjects showed consistent improvement in central macular thickness. CONCLUSIONS: Posterior sub-tenon triamcinolone acetonide can be considered a short-term treatment option in cases of refractory macular oedema.

Short-term clinical evaluation of different pharmaceutical forms of triamcinolone acetonide in the treatment of oral lichen planus of erosive type / 实用口腔医学杂志

Objective:To observe the efficacy of different forms of triamcinolone acetonide( TA) in the treatment of buccal erosive oral lichen planus (EOLP). Methods:120 EOLP patients were randomly divided into 4 groups(n=30) and treated with Kangfuxin mouth-wash followed by topical ointment of( TA) , TA injection, TA mouth-wash and only Kangfuxin mouth-wash only, respectively. Before treatment, 1, 2 and 4 weeks after treatment, the pain (VAS score) and erosion area were measured, the effects were compared among groups. Results:The VAS scores of A, B and C groups were significantly lower than those of the control group after 1, 2 and 4 week treatment, and the total effective rate was significantly higher than that of the control group, respectively(P0. 05). The average erosion area of group A and B was significantly smaller than that of the control group after 1, 2 and 4 week treatment(P0. 05), but 4 weeks after treatment, the average area of erosion of group C was significantly smaller than that of the control group(P<0. 05). Conclusion:Triamcinolone acetonide is effective in the treatment of OLP and the oral oint-ment form is safe and convenient for OLP treatment.

Safety and pharmacodynamics of suprachoroidal injection of triamcinolone acetonide as a controlled ocular drug release model.

Suprachoroidal injection is an emerging technique for drug delivery to the posterior segment, which is hard to reach by non-invasive approaches. However, the injection technique varies and the associated ocular safety is not well understood. In addition, it is not clear if drug formulation is a major factor in optimizing pharmacodynamics using this technique. The current study was designed to compare the suprachoroidal injection of different drug formulations and to characterize the safety and pharmacodynamics of triamcinolone acetonide (TA) delivered by this technique. Both indocyanine green (ICG) solution and TA suspension, at 50µL, 100µL, and 150µL, were suprachoroidally injected and intraocular pressure (IOP) tonometry, fundus photography, and electroretinography were performed over multiple time points up to eight weeks. After 50µL TA (Kenalog-40) suprachoroidal injection, 4-5 animals at 7 time points were sacrificed for aqueous, vitreous, retina, and plasma collections. TA was quantitated using ultra-performance liquid chromatography tandem mass spectrometry. For comparative efficacy study, 50µL (2mg) suprachoroidal TA versus 20mg subtenon TA were performed 4weeks before induction of experimental uveitis with 10ng of intravitreal lipopolysaccharide. After suprachoroidal injection, IOP had an acute elevation, higher volume caused higher IOP (p<0.0001). Equivalent volume of ICG solution led to a significantly smaller IOP elevation than after TA suprachoroidal injection. This finding suggests better distribution of ICG solution than TA suspension in the suprachoroidal space. Following a 50µL suprachoroidal injection, peak TA concentration in the aqueous was below 1ng/mL. In contrast, the posterior vitreous and retina had 1912ng/mL and 400,369ng/mL TA, respectively. Maximum TA in plasma was 11.6ng/mL. Drug exposure to the posterior retina was 523,910 times more than that to the aqueous and 29,516 times more than systemic TA exposure. In the treatment of lipopolysaccharide-induced uveitis, compared with 20mg subtenon injection, suprachoroidal 2mg TA demonstrated much better efficacy with significantly less aqueous humor cells and lower vitreous opacity scores (p<0.05). Histology showed much less vitreous inflammation in the suprachoroidal injection group (p<0.0001). It seems that a 50µL suprachoroidal injection of TA was well tolerated in rabbit eyes and demonstrated excellent penetration into the posterior retina, providing better therapeutic effect than subtenon 20mg TA.

Intravitreal Triamcinolone Acetonide as Adjunctive Treatment in Vitrectomy for Proliferative Diabetic Retinopathy

PURPOSE: This study evaluated the safety and efficacy of crystalline triamcinolone acetonide (TA) in pars plana vitrectomy for proliferative diabetic retinopathy. METHODS: A total of 152 eyes of 143 patients were enrolled in the study, and divided into 3 groups: Group I underwent pars plana vitrectomy without intravitreal injection of TA, group II underwent TA-assisted vitrectomy, and group III underwent TA-assisted vitrectomy and received an intravitreal injection of 4 mg TA at the end of surgery. RESULTS: In Groups I, II and III, 31 eyes (62.0%), 35 eyes (67.3%), and 41 eyes (82.0%), respectively, showed frequency of gain in visual acuity, group III showed greater improvements in vision after surgery than group I; the difference was statistically significant. Four eyes (8.0%) in group I, 12 eyes (23.1%) in group II, and 12 eyes (24.0%) in group III had an intraocular pressure higher than 21 mmHg after the operation; there were statistically significant differences in groups II and III compared to group I (P=0.04, P=0.03, respectively). Ten eyes (20.0%) in group I, 3 eyes (5.8%) in group II, and 3 eyes (6.0%) in group III needed additional surgery. Groups II and III, which received TA-assisted vitrectomy, had lower incidences of re-operation than group I (P=0.03, P=0.04, respectively). CONCLUSIONS: Triamcinolone acetonide-assisted vitrectomy appears to be a potentially useful way to reduce the incidence of re-operation and an intravitreal injection of TA at the end of surgery may be useful for improving postoperative visual acuity.

Comparison of Indocyanine Green and Triamcinolone Acetonide for Internal Limiting Membrane Peeling in Macular Hole

PURPOSE: To compare the surgical outcomes and complications of triamcinolone acetonide (TA) with those of indocyanine green (ICG) staining of the internal limiting membrane (ILM) during idiopathic macular hole surgery. METHODS: Twenty-four eyes of 23 consecutive patients with an idiopathic macular hole underwent vitrectomy, ILM peeling, and intravitreal gas injection. For enhanced visualization of ILM, ICG was used in 13 eyes and TA in the remaining 11 eyes. Functional and anatomical success rates and surgical complications were compared between the groups. RESULTS: The mean follow-up periods were 10.8 months (ICG group) and 7.5 months (TA group). Best corrected visual acuity increased by two or more lines in 10 eyes (76.9%) of the ICG group and in eight eyes (72.7%) of the TA group (P=1.000). Anatomical closure after the first surgery was achieved in 10 eyes (76.9%) of the ICG group and in all 11 eyes of the TA group (100%) (P=0.223). Postoperative atrophic changes in the retinal pigment epithelium (RPE) in the macular hole bed was found in two eyes of the ICG group and in three eyes of the TA group. All of these (5 eyes) showed the photoreceptor outer segment defect in the closed macular areas by optical coherence tomography and had a postoperative best corrected visual acuity of 0.3 or less. CONCLUSIONS: In view of the potential toxicities of ICG, TA appears to be a promising alternative adjuvant for ILM peeling during macular hole surgery. However, postoperative RPE atrophy was detected as a postoperative complication in both the ICG and TA groups. Further study is needed to evaluate the TA toxicity in macular hole surgery.

Efficacy of Intravitreal Triamcinolone Acetonide Injections at the End of Pars Plana Vitrectomy in Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the efficacy of intravitreal injections of triamcinolone acetonide (TA) at the end of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). METHODS: We analyzed 50 patients (52 eyes) who underwent PPV for treatment of PDR and received an intravitreal injection of 4 mg TA at the end of surgery. The study group (Group 1) was compared with a control group (Group 2, 46 patients, 51 eyes) (matched with the study group for preoperative parameters) who underwent PPV without intravitreal injection of TA. RESULTS: In Group 1, the grade of anterior chamber cells at postoperative days 1 and 7 was significantly lower than that of Group 2. There was slight mean IOP elevation in Group 1 at postoperative weeks 2, 3, 4, and 8, but it was not statistically significant. Forty-four eyes (84.6%) from Group 1 showed better visual acuity at the last follow-up than at the preoperative visit (Group 1). Thirty-two eyes (62.8%) from Group 2 showed better visual acuity at the last follow-up than at the preoperative visit. The degree of visual improvement was 0.75 logMAR in Group 1 and 0.59 logMAR in Group 2. Vitreous hemorrhage occurred in 9 eyes (17.3%) from Group 1 and in 19 eyes (37.3%) from Group 2. However, the differences in the occurrence of neovascularization in iris and neovascular glaucoma between two groups were not statistically significant. CONCLUSIONS: Intravitreal TA injection at the end of PPV seems to be effective in improving visual acuity and decreasing early postoperative inflammation and the frequency of vitreous hemorrhage.

A Case of Papular Elastorrhexis Improved by Intralesional Injections of Triamcinolone Acetonide / 대한피부과학회지

Papular elastorrhexis is a rare disorder characterized by multiple, white, non-follicular, firm papules usually occurring on the trunk during adolescence. Histologically, there are focal areas of collagen homogenization with decreased and fragmented elastic fibers. There has been no established treatment for this disease. We report a case of papular elastorrhexis in a 19-year-old female patient improved by intralesional injections of triamcinolone acetonide (TA).