Triamcinolone injection in the treatment of lid retraction for thyroid-associated ophthalmopathy: A systematic review.

INTRODUCTION AND OBJECTIVES: Lid retraction is one of the most common symptoms of Thyroid-Associated Ophthalmopathy (TAO), which potentially precipitates various complications, such as dry eyes, exposure keratopathy, and cosmetic concerns. Local corticosteroid injections, such as triamcinolone, have been proposed as a choice of treatment for TAO. This approach may be a favorable alternative for patients intolerant to the systemic effects of high-dose methylprednisolone. However, the efficacy of this intervention remains unestablished. Hence, our review aims to evaluate the efficacy of triamcinolone injection in reducing lid retraction. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and was conducted in three databases (PubMed, Science Direct, and ProQuest). This review included studies that use local triamcinolone injections for patients with thyroid-associated ophthalmopathy. The outcome of interest in this review is lid retraction parameters. RESULTS: From six studies, a total of 392 patients were included. All studies showed significant improvement in lid retraction in the patient who received triamcinolone (all p < 0.05) as shown by ΔMRD (-0.93 mm in 1 month and -1.38 mm in 3 months), ΔMLD (-1.98 mm at 6 months), and Δpalpebral fissure height (-1.68 in 1 month). The majority of studies showed rapid improvement in lid retraction in the first month of therapy. CONCLUSION: Triamcinolone injection is an effective therapy for lid retraction related to thyroid-associated ophthalmopathy.

Neuroprotective Strategies for Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review.

PURPOSE: Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there is still no definitive therapy for NAION. The available literatures on the possible treatment of NAION are quite diverse and controversial. Neuroprotection strategies have been suggested as one of the potential treatments for NAION. This review aims to critically evaluate the literature on neuroprotective strategy for NAION. METHODS: This report was written in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a systematic literature search in Pubmed, Science Direct, Proquest, and Cochrane databases. Only neuroprotective agents that directly work in protecting neurons were included. The outcome of interest in this review is retinal ganglion cell density and apoptosis for animal studies and retinal nerve fiber layer thickness for human studies. RESULTS: The systematic search identified 591 studies of which 24 met the eligibility criteria, including 21 animal studies and three human studies. Only a few of the studies evaluated the same treatments, showing how diverse neuroprotector treatments are currently being evaluated as NAION treatment. From 21 animal studies, 14 studies showed significantly higher retinal ganglion cell density (1.49- to 2.81-fold) with neuroprotective treatment compared to control group. Two of three human studies in this review had also found a beneficial effect of preserving retinal nerve fiber layer thickness in NAION patients. CONCLUSIONS: This review suggests the potential of neuroprotection as a viable option in the quest for an effective treatment strategy for NAION. Further studies, particularly clinical studies, are necessary to establish its efficacy in NAION patients.

The use of artificial intelligence in detecting papilledema from fundus photographs.

Papilledema is an optic disc swelling with increased intracranial pressure as the underlying cause. Diagnosis of papilledema is made based on ophthalmoscopy findings. Although important, ophthalmoscopy can be challenging for general physicians and nonophthalmic specialists. Meanwhile, artificial intelligence (AI) has the potential to be a useful tool for the detection of fundus abnormalities, including papilledema. Even more, AI might also be useful in grading papilledema. We aim to review the latest advancement in the diagnosis of papilledema using AI and explore its potential. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A systematic literature search was performed on four databases (PubMed, Cochrane, ProQuest, and Google Scholar) using the Keywords "AI" and "papilledema" including their synonyms. The literature search identified 372 articles, of which six met the eligibility criteria. Of the six articles included in this review, three articles assessed the use of AI for detecting papilledema, one article evaluated the use of AI for papilledema grading using Frisèn criteria, and two articles assessed the use of AI for both detection and grading. The models for both papilledema detection and grading had shown good diagnostic value, with high sensitivity (83.1%-99.82%), specificity (82.6%-98.65%), and accuracy (85.89%-99.89%). Even though studies regarding the use of AI in papilledema are still limited, AI has shown promising potential for papilledema detection and grading. Further studies will help provide more evidence to support the use of AI in clinical practice.

Alkaline Diuresis as Treatment for 2,4-D Dimethylamine Herbicide Intoxication.

Acute intoxication with 2,4-D dimethylamine is rare, often fatal and can cause signs and symptoms in different organ systems. This case report describes the effectiveness of alkaline diuresis as a life-saving treatment for chlorophenoxy intoxication, especially in healthcare facilities without access to haemodialysis. A patient had attempted suicide by ingesting 2,4-D dimethylamine, with toxic effects on the central and peripheral nervous systems, and the gastrointestinal and respiratory systems. However, she significantly improved after alkaline diuresis, accompanied by resuscitation, decontamination of the gastrointestinal system, and supportive therapies. LEARNING POINTS: With no known of antidote, 2,4-D dimethylamine intoxication can be fatal if not treated promptly.Alkaline diuresis can be a life-saving treatment, especially in rural area with no access to haemodialysis.Treatment with alkaline diuresis can give a good result in patients who present with severe intoxication.