Kenalog
Intractable glaucoma following intravitreal triamcinolone in central retinal vein occlusion.

Kaushik S, Gupta V, Gupta A, Dogra MR, Singh R.

Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

PURPOSE: To document secondary glaucoma observed after intravitreal injection of triamcinolone for cystoid macular edema in central retinal vein occlusion. DESIGN: An interventional case series. METHODS: Retrospective study. The setting was a tertiary care referral institute. Nine patients with central retinal vein occlusion and cystoid macular edema received 4.0 mg/0.1 ml of intravitreal triamcinolone acetate injected through the inferior pars plana under topical anesthesia. Baseline intraocular pressures were normal in all, and no patients had glaucoma. RESULTS: Seven of the nine patients had a post-injection rise in intraocular pressures, of which one had intractable secondary glaucoma requiring removal of the depot corticosteroid by pars plana vitrectomy combined with trabeculectomy. Two patients were controlled only by maximal medical therapy. CONCLUSIONS: The occurrence of intractable glaucoma after intravitreal triamcinolone in central retinal vein occlusion is a serious concern and warrants caution in the use of this modality for these patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15059722&dopt=Abstract triamcinolone Kenalog



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[Intraocular pressure elevation after subtenon injection of triamcinolone acetonide during uveitis]

[Article in French]

Bui Quoc E, Bodaghi B, Adam R, Burtin T, Cassoux N, Dreifuss S, Fardeau C, LeHoang P.

Service d'Ophtalmologie, Groupe Hospitalier Pitie-Salpetriere, 47-83, boulevard de l'hopital, 75651 Paris cedex 13, France.

INTRODUCTION: New therapeutic concepts in the management of ocular inflammation have led to the development of periocular and intravitreal injections. Such treatment modalities can induce intraocular pressure elevation. PATIENTS AND METHODS: Periocular injections have been given to patients suffering from strictly unilateral or bilateral but asymmetrical and noninfectious posterior uveitis. A history of corticosteroid-induced glaucoma was a contraindication to such treatment. A retrospective review of cases who were given subtenon triamcinolone acetonide injection between May and October 2001 was undertaken to evaluate the efficacy of the treatment and the risk of intraocular pressure elevation. Ocular pressure was measured before and after the injection and the efficacy of the treatment was evaluated by measurements of visual acuity and fluorescein angiography. RESULTS: One or several injections were given to 61 patients. Intraocular pressure rose in 13 patients (21.3%). Medical treatment was unsuccessful in three cases and surgical excision of periocular corticosteroid deposit was required. Therefore, intraocular pressure was controlled with no other medication. Treatment was considered effective in 32 patients (52.45%): improvement of visual acuity (more than two lines) or control of inflammation on fluorescein angiography. DISCUSSION: and conclusions: Periocular subtenon injection of triamcinolone acetonide in posterior noninfectious uveitis is a safe procedure. Intraocular pressure elevation is not frequent and can be controlled through medical treatment or surgical excision of a residual deposit, in which pharmacologically active triamcinolone can be present several months after the injection.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12527830&dopt=Abstract triamcinolone Kenalog



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Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide.

Jonas JB, Akkoyun I, Kamppeter B, Kreissig I, Degenring RF.

Department of Ophthalmology and Eye Hospital, Faculty for Clinical Medicine, Mannheim Ruprecht-Karls-University, Heidelberg, Germany. Jost.Joas augen.ma.uni-heidelberg.de

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity in branch retinal vein occlusion. METHODS: The prospective comparative nonrandomized clinical interventional study included 28 patients (28 eyes) with branch retinal vein occlusion. The study group consisting of 10 consecutive patients received an intravitreal injection of 20-25 mg of triamcinolone acetonide. The control group including 18 patients did not receive an intravitreal injection. The mean follow-up was 8.7+/-4.4 months. RESULTS: In the study group, mean visual acuity increased significantly (P=0.02) from 0.27+/-0.11 preoperatively to a best postoperative visual acuity of 0.45+/-0.27. Visual acuity measurements determined 1 month after the injection were significantly (P=0.027) higher than baseline values. Nine (90%) eyes gained in visual acuity, with six (60%) eyes showing an increase in visual acuity of at least two Snellen lines. In the ischaemic subgroup, visual acuity did not change significantly (0.18+/-0.18 to 0.13+/-0.04; P=0.66), while, in the nonischaemic subgroup, visual acuity increased significantly (P=0.012) from the baseline value to the best postoperative measurement (0.29+/-0.09 to 0.53+/-0.24). In the control group, baseline visual acuity and best visual acuity during the follow-up did not vary significantly (P=0.27). Comparing the study and control groups with each other, the gain in visual acuity was significantly higher in the study group at 1 month (P=0.016) and 2 months (P=0.012) after baseline. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide can increase visual acuity in patients with branch retinal vein occlusion.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15105817&dopt=Abstract triamcinolone Kenalog



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Triamcinolone suppresses human tenocyte cellular activity and collagen synthesis.

Wong MW, Tang YN, Fu SC, Lee KM, Chan KM.

Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong. mwnwong cuhk.edu.hk

Glucocorticoid injection is widely used in tendon disorders. Despite previous studies on the histologic and biomechanical changes in tendons after glucocorticoid injections, the role of glucocorticoid in tendon rupture still is controversial. It was hypothesized that glucocorticoid has a direct deleterious effect on human tenocytes, suppressing its cellular activity and collagen production. Primary cultures of human tenocytes were obtained from explants of healthy patellar tendon harvested during anterior cruciate ligament reconstructions. The effects on cell viability and cell proliferation were measured by [3-(4,5-demethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay and 5-bromo-deoxyuridine incorporations. The effect on collagen synthesis was measured by H-proline incorporation assay. Triamcinolone acetonide at 10 to 10 mol/L decreased human tenocyte viability to 45% to 88% of control in a dose-dependent manner. Cell proliferation was suppressed to 87% +/- 8% at all doses. Treatment with 1 micromol/L triamcinolone acetonide reduced the amount of collagen synthesis as measured by H-proline incorporation from 40 +/- 2 cpm/1000 cells to 27 +/- 4 cpm/1000 cells. The suppressed human tenocyte cellular activity and reduced collagen production may lead to disturbed tendon structure and predispose the tendon to subsequent spontaneous rupture.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15123960&dopt=Abstract triamcinolone Kenalog



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Grey scale and power Doppler sonographic changes induced by intra-articular steroid injection treatment.

Filippucci E, Farina A, Carotti M, Salaffi F, Grassi W.

Department of Rheumatology, Universita Politecnica delle Marche, Italy.

OBJECTIVE: To investigate the ability of high resolution grey scale sonography (GSS) and power Doppler sonography (PDS) to assess short term soft tissue changes induced by intra-articular steroid injection in the small joints of patients with chronic synovitis. METHODS: 20 patients with clinically active synovitis of a small joint unresponsive to systemic drug treatment underwent a sonographic guided intralesional injection with triamcinolone acetonide. Clinical examinations were carried out by a trained rheumatologist. GSS and PDS examinations were performed independently by two examiners unaware of the results of the clinical examination. Joint cavity widening and power Doppler signal were evaluated and graded on a semiquantitative scale ranging from 1 to 4. Clinical and sonographic follow up examinations were carried out 2 weeks after the injection with triamcinolone acetonide. RESULTS: All intra-articular injections were successfully carried out and documented under sonographic guidance. In 19/20 patients, baseline sonographic examinations clearly detected morphological and perfusional signs of synovitis. At follow up examinations, clinical and sonographic scores had improved significantly. CONCLUSION: GSS and PDS appear to be a useful adjunctive tool for assessing short term soft tissue changes induced by intra-articular injection treatment with triamcinolone acetonide in small joints of patients with chronic arthritis.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15140784&dopt=Abstract triamcinolone Kenalog



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[Teatment of oral lichen planus with chloroquine and triamcinolone-A]

[Article in Chinese]

Cao HK, Zhang SL, Xu WN, Zhou ZT.

Research Institute of Stomatology,School of Stomatology,Shanghai Second Medical University. Shanghai 200011,China.

In this study,single blind grouping method was applied to compare the effect of chloroquine and triamcinolone-A which were used to treat 360 cases of oral lichen planus.The results showed the effect of local injecting triamcinolone-A was better than that of taking chloroquine,and also was better than that of taking triamcinolone-A accompained of chloroquine.Therefore,they were two effective ways to cure OLP and worthy of wide use.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15160004&dopt=Abstract triamcinolone Kenalog