PURPOSE: To evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure. METHODS: Patients with DME and central subfield thickness (CST) >300 microm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after > or =3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography. RESULTS: Forty eyes of 34 patients were included. The average baseline CST was 476 microm. The average CST decreased to 368 microm at 2 months, 374 microm at 4 months, and 427 microm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected. CONCLUSIONS: Posterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.
Aged ; Angiogenesis Inhibitors/*therapeutic use ; Bevacizumab/*therapeutic use ; Diabetic Retinopathy/diagnostic imaging/*drug therapy/physiopathology ; Female ; Glucocorticoids/*administration & dosage ; Humans ; Injections, Intraocular ; Intraocular Pressure/physiology ; Intravitreal Injections ; Macular Edema/diagnostic imaging/*drug therapy/physiopathology ; Male ; Middle Aged ; Retrospective Studies ; Tenon Capsule/*drug effects ; Tomography, Optical Coherence ; Treatment Failure ; Triamcinolone Acetonide/*administration & dosage ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/physiology

Administration, Cutaneous ; Administration, Topical ; Betamethasone Valerate ; therapeutic use ; China ; Clobetasol ; therapeutic use ; Cohort Studies ; Diabetes Mellitus ; epidemiology ; Ethnic Groups ; statistics & numerical data ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Hyperlipidemias ; epidemiology ; India ; Lichen Planus ; drug therapy ; epidemiology ; Malaysia ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Triamcinolone ; therapeutic use

The Diabetic Retinopathy Clinical Research Network (DRCR.net) performs studies on new treatments for diabetic retinopathy. This review aims to summarise recent findings from DRCR.net studies on the treatment of diabetic macular oedema. We performed a PubMed search of articles from the DRCR.net, which included all studies pertaining to the treatment of diabetic maculopathy. The main outcome measures were retinal thickening as assessed by central subfield thickness on optical coherence tomography and improvement of visual acuity on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Findings from each study were divided into modalities of treatment, namely photocoagulation, bevacizumab, triamcinolone, ranibizumab and vitrectomy. While modified ETDRS focal/grid laser remains the standard of care, intravitreal corticosteroids or anti-vascular endothelial growth factor agents have also proven to be effective, although they come with associated side effects. The choice of treatment modality for diabetic macular oedema is a clinical judgement call, and depends on the patient's clinical history and assessment.
Adrenal Cortex Hormones ; therapeutic use ; Bevacizumab ; therapeutic use ; Biomedical Research ; organization & administration ; Diabetic Retinopathy ; therapy ; Disease Management ; Disease Progression ; Humans ; Light Coagulation ; Macular Edema ; therapy ; Ranibizumab ; therapeutic use ; Retina ; pathology ; Tomography, Optical Coherence ; Triamcinolone ; therapeutic use ; Vascular Endothelial Growth Factor A ; antagonists & inhibitors ; Visual Acuity ; Vitrectomy

No abstract available.
Arthritis, Gouty/drug therapy/*metabolism/*radiography ; Calcium Pyrophosphate/*analysis ; Crystallization ; Female ; Glucocorticoids/administration & dosage ; Humans ; Injections, Intra-Articular ; Knee Joint/*chemistry/drug effects/*radiography ; Middle Aged ; Predictive Value of Tests ; Tomography, X-Ray Computed/*methods ; Treatment Outcome ; Triamcinolone/administration & dosage

INTRODUCTIONThis study aimed to evaluate the efficacy and safety of intra-articular glucocorticoid (IAG) injections in our institution in children with juvenile idiopathic arthritis (JIA).

METHODSThis is a retrospective assessment of IAG injections performed by the Department of Paediatrics, National University Hospital, Singapore, from October 2009 to October 2011. A total of 26 procedures were evaluated for efficacy, considering parameters such as clinical response, changes in systemic medication, length of time between repeat injections, safety, consent-taking, pre- and post-procedural advice, compliance with aseptic technique, and post-procedural complications.

RESULTSA total of 26 IAG injections of triamcinolone hexacetonide were administered over 17 occasions (i.e. patient encounters) to ten patients with JIA during the study period. After the injections, clinical scoring by a paediatric rheumatologist showed overall improvement by an average of 2.62 points out of 15. Besides six patient encounters that had an increase in systemic medication on the day of the injection, five required an increase within six months post injection, two required no adjustments, and one resulted in a decrease in medications. In all, 21 injections did not require subsequent injections. The mean interval between repeat injections was 7.8 months. Cutaneous side effects were noted in three anatomically difficult joints. Medical documentation with regard to patient progress was found to be lacking.

CONCLUSIONAs per the recommendations of the American College of Rheumatology, we safely used IAG injections as the first-line therapy in our group of patients with oligoarticular JIA, and/or as an adjunct to systemic therapy in our patients with JIA.

Adolescent ; Anti-Inflammatory Agents ; administration & dosage ; Arthritis, Juvenile ; drug therapy ; Child ; Child, Preschool ; Female ; Glucocorticoids ; administration & dosage ; Humans ; Injections, Intra-Articular ; Male ; Pediatrics ; methods ; Retrospective Studies ; Singapore ; Skin ; drug effects ; Treatment Outcome ; Triamcinolone Acetonide ; administration & dosage ; analogs & derivatives

PURPOSE: To compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: We reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase. RESULTS: Totals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups. CONCLUSIONS: Although IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Female ; Follow-Up Studies ; Glucocorticoids/administration & dosage ; Humans ; Intravitreal Injections ; Laser Therapy/*methods ; Macular Edema/diagnosis/etiology/*therapy ; Male ; Middle Aged ; Recurrence ; Retinal Vein Occlusion/*complications/diagnosis/therapy ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Visual Acuity

PURPOSE: To compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS: We reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase. RESULTS: Totals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups. CONCLUSIONS: Although IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.
Angiogenesis Inhibitors/administration & dosage ; Antibodies, Monoclonal, Humanized/*administration & dosage ; Female ; Follow-Up Studies ; Glucocorticoids/administration & dosage ; Humans ; Intravitreal Injections ; Laser Therapy/*methods ; Macular Edema/diagnosis/etiology/*therapy ; Male ; Middle Aged ; Recurrence ; Retinal Vein Occlusion/*complications/diagnosis/therapy ; Retrospective Studies ; Tomography, Optical Coherence ; Treatment Outcome ; Triamcinolone Acetonide/*administration & dosage ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors ; Visual Acuity

OBJECTIVETo compare the clinical therapeutic effects between ozone and triamcinolone acetonide for the treatment of mild meniscal injury.

METHODSFrom January 2008 to December 2012, 119 patients with meniscal injury diagnosed as type I or II by MRI were divided into three groups. In the triamcinolone acetonide (A) group, there were 38 males and 2 females, with an average age of (25.34 +/- 6.34) years old, ranging from 18 to 48 years old; 36 patients had single knee injuries, 4 patients had double knee injuries and 44 knees with joint effusion. In the ozone (B) group,there were 37 males and 2 females, with an average age of (26.98 +/- 7.20) years old, ranging from 19 to 50 years old; 33 patients had single knee injuries, 6 patiens had double knees injuries and 40 knees with joint effusion. In the combination of ozone and triamcinolone acetonide (C) group, there were 37 males and 3 females,with an average age of (26.44 +/- 6.38) years old, ranging from 18 to 47 years old; 33 patients had single knee injuries, 7 patients had double knees injuries and 39 knees with joint effusion. The patients were treated with injection of 3 mg triamcinolone acetonide alone, 30 ml (30 microg/ml) ozone alone, or both two drugs respectively in knee joint cavity. All the treatment methods were carried out weekly and 4 times injections were required for a treatment course. Knee joint function was evaluated by Lysholm scale and knee joint effusion was examined by MRI before and after treatment.

RESULTSThe scale of knee joint function was 35.68 +/- 4.15 and 65.55 +/- 7.66 in group A, 36.35 +/- 6.83 and 74.39 +/- 8.47 in group B, 36.62 +/- 6.03 and 95.47 +/- 4.78 in group C before and after treatment. Compared with that before treatment, the total scale of knee joint function improved after treatment in every group. The total scale of group C was better than that of the other groups after the treatment,but there was no significant difference between group A and group B. The effective rate of these drugson joint effusion was 68.18% in group A, 62.5% in group B and 87.18% in group C. The effect of co-injection on joint effusion in group C was significantly better than that of triamcinolone acetonide or ozone alone, but the difference between group A and group B was not significant.

CONCLUSIONOzone and triamcinolone acetonide are effective in the treatment of mild meniscal injury, which can relieve symptoms and promote the recovery of joint function. Campared with the single injection, the combination of ozone and triamcinolone acetonide is better.

Adult ; Case-Control Studies ; Female ; Humans ; Knee Injuries ; drug therapy ; Male ; Menisci, Tibial ; drug effects ; Middle Aged ; Ozone ; administration & dosage ; Triamcinolone Acetonide ; administration & dosage ; Young Adult

OBJECTIVETo explore the effects of sacral canal injection on nerve root local inflammatory factors in rat model with lumbar disc herniation, in order to identify its mechanism of treatment.

METHODSForty-eight male SD rats were randomly divided into sham operation group(group A), model group (group B), Chinese medicine group(group C) and western medicine group(group D). There were 12 rats in each group. The model of lumbar disc herniation was established using compression and inflammatory stimulation in group B, C, D. All rats were given epidural catheterization and group A and B with physiological saline (1 ml/kg), group C with mixed liquor of 2% lidocaine and compound Danshen injections and physiological saline (2:2: 16) and group D with mixed liquor of 2% lidocaine and triamcinolone acetonide injection and physiological saline (2:2:16), once a week for a total of three treatments. Four rats were killed every 1 week after injection for once, and the inflammatory factors of tumor necrosis factor (TNF-alpha), prostaglandin E2 (PGE2), interleukin-l (IL-1) and interleukin-6 (IL-6) were detected by ELISA method.

RESULTSThe levels of TNF-alpha, PGE2, IL-1 and IL-6 in compressed nerve tissues in group B were increased than those of group A (P < 0.01). The levels of PGE2, IL-1 and IL-6 in group C and D were decreased than those of group B, and group D was much less(P<0.05). There was no significant difference in level of TNF-alpha among group B, C, D (P > 0.05).

CONCLUSIONCompound compression with inflammatory stimulation can lead to massive release of inflammatory mediators, such as TNF-alpha, PGE2, IL-1 and IL-6. Both injection with compound Danshen injections and triamcinolone acetonide injections by sacral canal can reduce the levels of part inflammatory mediators (PGE2, IL-1 and IL-6), and the effect of Glucocorticoid is better than Danshen (P < 0.05).

Animals ; Dinoprostone ; analysis ; Disease Models, Animal ; Injections ; Interleukin-1 ; analysis ; Interleukin-6 ; analysis ; Intervertebral Disc Displacement ; drug therapy ; immunology ; Lumbar Vertebrae ; Male ; Rats ; Rats, Sprague-Dawley ; Salvia miltiorrhiza ; Spinal Nerve Roots ; immunology ; Triamcinolone Acetonide ; administration & dosage ; Tumor Necrosis Factor-alpha ; analysis

We present a case of ocular toxocariasis treated successfully with oral albendazole in combination with steroids. A 26-year-old male visited the authors' clinic with the chief complaint of flying flies in his right eye. The fundus photograph showed a whitish epiretinal scar, and the fluorescein angiography revealed a hypofluorescein lesion of the scar and late leakage at the margin. An elevated retinal surface and posterior acoustic shadowing of the scar were observed in the optical coherence tomography, and Toxocara IgG was positive. The patient was diagnosed with toxocariasis, and the condition was treated with albendazole (400 mg twice a day) for a month and oral triamcinolone (16 mg for 2 weeks, once a day, and then 8 mg for 1 week, once a day) from day 13 of the albendazole treatment. The lesions decreased after the treatment. Based on this study, oral albendazole combined with steroids can be a simple and effective regimen for treating ocular toxocariasis.
Adult ; Albendazole/administration & dosage/*therapeutic use ; Anthelmintics/administration & dosage/therapeutic use ; Anti-Inflammatory Agents/administration & dosage/therapeutic use ; Eye Diseases/*drug therapy/*parasitology ; Humans ; Male ; Toxocariasis/*drug therapy ; Triamcinolone/administration & dosage/*therapeutic use