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Invest Ophthalmol Vis Sci. 2008 Sep 29;
Breusegem C, Vandewalle E, Van Calster J, Stalmans I, Zeyen TG
Purpose: To investigate the diagnostic value of a topical dexamethasone (DXM) provocative test before intravitreal triamcinolone acetonide (IVTA) injection for a steroid response. Methods: Eligible patients scheduled for first-time IVTA without glaucoma or a history of a steroid response received dexamethasone 0.1% drops four times daily over four weeks, whereafter IVTA was given except in DXM responders with an IOP rise >15mmHg. The IOP was measured at baseline, four weeks after DXM treatment, and at weeks 1, 2, and 4, and months 3 and 6 after IVTA. A steroid response after the DXM test or after IVTA was defined as an IOP rise >/=6 mmHg. Results: Thirty-six patients (36 eyes) were analyzed. The DXM test had a sensitivity of 25% (95%CI[0.07,0.52]), a specificity of 100% (95%CI[0.83,1.00]), a positive predictive value of 100% (95%CI[0.40,1.00]) and a negative predictive value of 62% (95%CI[0.44,0.79]) for a steroid response after IVTA. In DXM responders, the IOP rise after IVTA was 17.0+/-7.8mmHg vs. 5.0+/-4.4mmHg in DXM non-responders (P=0.005). The IOP rise after the DXM test correlated with the IOP rise after IVTA (P=0.001). Conclusion: The topical DXM test had a low sensitivity, a high specificity, a high positive and a moderate negative predictive value and may be useful to predict a steroid response following IVTA. DXM responders demonstrated a high IOP rise after IVTA and the IOP rise after the DXM test correlated with the IOP rise after IVTA. If the DXM test is positive, risks and benefits of IVTA should be more carefully weighted.
Eye. 2008 Sep 26;
Costa DC, de Castro RS, Kara-Jose N
PurposeTo assess the safety and effectiveness of treating corneal endothelial rejection with a subconjunctival injection of 20 mg triamcinolone acetonide in combination with topical application of 1% prednisolone acetate, as compared to treatment with an intravenous pulse of 500 mg methylprednisolone in combination with topical application of 1% prednisolone acetate.MethodsA case-controlled study including a literature review was performed. Patients who presented with an initial episode of corneal endothelial rejection were treated with subconjunctival injection of 20 mg triamcinolone in combination with topically applied 1% prednisolone and were retrospectively matched for age and diagnosis to patients who received a single intravenous injection of 500 mg methylprednisolone in combination with topical 1% prednisolone. Patients were analysed regarding reversion of the rejection episode, intraocular pressure, and visual acuity after 1 year.ResultsOverall, the triamcinolone group had a better outcome regarding reversion of corneal transplant rejection (P=0.025), with 15 of 16 patients in the triamcinolone group having clear grafts, compared to only 10 of 16 patients in the methylprednisolone group. Intraocular pressure (IOP) was increased in both groups at day 30 (P=0.002), although there was no statistically significant difference in IOP between the groups (P=0.433). Visual acuity improved in both groups after 1 year (P=0.049), although slightly more improvement was observed in the triamcinolone group (P=0.002).ConclusionsThe results observed in this case-controlled study suggest that the use of subconjunctival triamcinolone acetonide may benefit patients with corneal transplant rejection.Eye advance online publication, 26 September 2008; doi:10.1038/eye.2008.289.
J Cataract Refract Surg. 2008 Oct; 34(10): 1669-73
Cebulla CM, Alegret AM, Feuer WJ, Shi W, Schefler AC, Murray TG
PURPOSE: To study the reduction in tumor size and the safety and efficacy of combined phacoemulsification and intravitreal triamcinolone acetonide injection (phaco-IVTA) in patients with treated melanoma and atypical nevi. SETTING: Bascom Palmer Eye Institute, Miami, Florida, USA. METHODS: The medical records of 49 consecutive patients (51 eyes) with treated melanoma or atypical nevi treated with phaco-IVTA were evaluated retrospectively for changes in Snellen visual acuity, tumor volume, and frequency of complications. Main outcome measures included a postsurgical change in tumor size greater than or equal to 0.5 mm of height or 1.0 mm of basal diameter by echographic analysis, improvement in visual acuity at 6 months and final follow-up, and complications including endophthalmitis, cystoid macular edema, epiretinal membrane, increased intraocular pressure, and persistent corneal edema. RESULTS: The median baseline visual acuity was 20/80 in the affected eye. At the 6-month follow-up examination, 13 (68%) of 19 eyes had achieved better than 20/40 visual acuity. Treated uveal melanomas (n = 30) and atypical choroidal nevi (n = 21) were stable with combined therapy, and echographic measurements improved in 12 eyes. Intraocular pressure increased from baseline to 25 mm Hg or more postoperatively in 4 of 51 eyes (8%). No other significant complications occurred. CONCLUSIONS: Combined phacoemulsification and IVTA was reasonably safe in patients with treated melanoma and atypical nevi. Tumors remained stable or decreased slightly in size. Intravitreal triamcinolone acetonide injection at the time of cataract surgery in patients with treated melanoma or nevus may reduce rates of tumor progression in these patients.
Frontal fibrosing alopecia: clinical presentations and prognosis.
Br J Dermatol. 2008 Sep 22;
Tan KT, Messenger AG
Background Frontal fibrosing alopecia is an uncommon condition characterized by progressive frontotemporal recession due to inflammatory destruction of hair follicles. Little is known about the natural history of this disease. Objectives To determine the clinical features and natural history of frontal fibrosing alopecia. Methods We studied the cases notes of patients diagnosed with frontal fibrosing alopecia from 1993 to 2008 at the Royal Hallamshire Hospital, Sheffield. Results There were 18 patients aged between 34 and 71 years. Three were premenopausal. All had frontotemporal recession with scarring. This was associated with partial or complete loss of eyebrows in 15 patients while four had hair loss at other sites. One had keratosis pilaris-like papules on the face, and one had follicular erythema on the cheeks. Three patients had oral lichen planus, of whom two also had cutaneous lichen planus affecting other sites of the body. Treatments given included intralesional triamcinolone acetonide, 0.1% tacrolimus ointment and oral hydroxychloroquine. Progression of frontotemporal recession was seen in some patients, but not all. In one patient the hair line receded by 30 mm over 72 months, whereas in another patient there was no positional change in the hair line after 15 years. Conclusions Frontal fibrosing alopecia is more common in postmenopausal women, but it can occur in younger women. It may be associated with mucocutaneous lichen planus. Recession of the hair line may progress inexorably over many years but this is not inevitable. It is not clear whether or not treatment alters the natural history of the disease - the disease stabilized with time in most of the patients with or without continuing treatment.
Phytother Res. 2008 Sep 19;
Martins MD, Marques MM, Bussadori SK, Martins MA, Pavesi VC, Mesquita-Ferrari RA, Fernandes KP
The comparison of chamomile and corticosteroids for treating ulcers was done in vitro and in vivo. The experimental groups were: control; chamomile recutita; triamcinolone acetonide and clobetasol propionate. For the in vitro study the cell viability of fibroblasts cultured for 24 h in media conditioned by the substances was obtained by the MTT reduction analysis. For the in vivo study, 125 male rats were submitted to experimental ulcers treated or not (control) by the substances tested. At 1, 3, 5, 7 and 14 days later 5 animals of each group were sacrificed. The lesions were analyzed by means of clinical observation and histological wound-healing grading. Data were compared by ANOVA (p
Dermatol Surg. 2008 Sep 15;
Koc E, Arca E, Surucu B, Kurumlu Z
BACKGROUND Various treatment regimens have been used in scars. The literature offers little consensus about appropriate therapy. OBJECTIVE To compare intralesional triamcinolone acetonide (TAC) alone or combined with onion extract in keloidal and hypertrophic scars. MATERIALS AND METHODS Fourteen patients were treated with intralesional TAC and onion extract gel, and 13 patients were treated with intralesional TAC alone. Findings were recorded and graded at each visit (weeks 0, 4, 12, and 20). The scores before treatment and at week 20 were compared. RESULTS Twenty-seven patients [17 men (63%) and 10 women (37%) aged 15 to 73 (average age 28.1+/-11.7)] were enrolled in the study. At baseline, the difference in the two treatment groups was not statistically significant (p>.05). At week 20, there was statistically significant improvement in both treatment groups (p
Arq Bras Oftalmol. 2008 Jul-Aug; 71(4): 493-8
Saraiva FP, Queiroz MS, Costa PG, Gasparin F, Nakashima Y
PURPOSE: To assess the efficacy of intravitreal use of triamcinolone acetonide combined with laser photocoagulation for the treatment of diffuse diabetic macular edema and to compare it with the separate use of each treatment. METHODS: After systemic clinical control, thirty patients with diffuse diabetic macular edema were divided into 3 treatment groups: (1) macular grid photocoagulation; (2) intravitreal injection of 4 mg of triamcinolone acetonide; (3) combination of the two previous therapies. Follow-up was scheduled at predetermined intervals of one day, one week and monthly until completion of six months. The following parameters were analyzed: LogMAR best corrected visual acuity, central macular thickness, total macular volume and intraocular pressure. RESULTS: Grid photocoagulation did not significantly reduce the central macular thickness or the total macular volume. On the other hand, this reduction was statistically significant in the other two groups. All groups improved their mean visual acuity, however, the group that received both treatments had a higher percentage of patients that gained 10 or more letters. CONCLUSION: The simultaneous administration of grid photocoagulation with intravitreal triamcinolone can be considered an option for the treatment of diffuse diabetic macular edema.
J Med Invest. 2008 Aug; 55(3-4): 279-82
Sato H, Naito T, Matsushita S, Takebayashi M, Shiota H
PURPOSE: To determine whether or not a sub-Tenon's capsule injection of triamcinolone acetonide(TA) is an effective treatment for refractory diabetic macular edema after vitrectomy. METHODS: Thirty-nine eyes of 26 patients with diabetic macular edema were injected with 20 mg TA into the sub-Tenon's capsule. The central macular thickness (CMT) measured by an optical coherence tomography (OCT) and visual acuities were compared between pre-treatment and 1, 3 months post-treatment. RESULTS: The decrease in the mean CMT between the baseline (435 microm) and 1 month (326 microm) or 3 months (303 microm) time points was statistically significant. Seven eyes (70%) at 1 month and 3 months post-treatment in the vitrectomized eyes or PPV(pars plana vitrectomy)(+) group, 15 eyes(52%) at 1 month, and 19 eyes (66%) at 3 months in the non-vitrectomized eyes or PPV(-)group maintained 20% reduction in CMT from pre-treatment with a single injection of TA. The recurrence of macular edema was observed in 1 eye (14%) in the PPV(+)group, and 3 eyes (16%) in the PPV(-)group. CONCLUSION: The sub-Tenon's capsule injection of TA was effective for refractory diabetic macular edema after vitrectomy. In addition, it was suggested that the treatment of vitrectomized eyes was more effective than that of non-vitrectomized eyes.
J Pain Symptom Manage. 2008 Sep 11;
Jenkin RP, Bamford R, Patel V, Kelly L, Stern S
Acta Ophthalmol. 2008 Sep 10;
Larsson J, Kifley A, Zhu M, Wang JJ, Mitchell P, Sutter FK, Gillies MC
Purpose: To assess the effect of triamcinolone acetonide over 3 months on hard exudates in patients with diabetic macular oedema (DMO). Methods: Thirty-two eyes of 16 patients with DMO and hard exudates were included in a randomized, placebo-controlled trial. Treated eyes received a single-dose (4 mg) intravitreal injection of triamcinolone acetonide. Control eyes received an injection of subconjunctival saline. Results: The overall area of hard exudates decreased significantly between the baseline and 3-month visits in treated eyes, but not in control eyes. The mean change in level of hard exudates between the two visits was - 0.75 arbitrary units (AU) (95% confidence interval [CI] - 1.32 to - 0.18) in the central plus inner circle (1500 mum) and - 0.81 AU (95% CI - 1.49 to - 0.13) over the whole grid (3000 mum) in treated eyes, compared with 0.31 AU (95% CI - 0.19 to 0.82) and 0.31 AU (95% CI - 0.11 to 0.74), respectively, in control eyes (p < 0.001). Mean visual acuity improved by five letters in treated but not in control eyes (p = 0.01). Conclusions: Intravitreal triamcinolone reduces hard exudates in the short-term in eyes with DMO.