Role of Sub-Silicone Oil Application of Triamcinolone Acetonide (TA) Drops on Outcomes After 360° Relaxing Retinectomy in Extreme Proliferative Vitreoretinopathy Cases- A Pilot Study.

Purpose: To perform a pilot study to evaluate the role of sub-silicone oil Triamcinolone Acetonide (TA) crystal drops in complex Retinal Detachment (RD) with extreme proliferative vitreoretinopathy (PVR) requiring 360-degree relaxing retinectomy (RR). Design: It was a retrospective pilot studyMaterials & methods : It was a retrospective, case-control pilot study. TA assisted 23G or 25G vitrectomy was done in 24 complex RDs with extreme PVR where 360 degree RR had to be performed. Group A (n=13) included cases where additional TA crystal drops were applied, after settling the detached retina, over the site of RR under silicone oil (SO 5000 cSt) tamponade. In control arm, group B (n=11), additional TA crystals were not applied. Main outcomes measured : Mean pre and post operative BCVA, ultra-widefield retinograph by Optos 200Tx, macular OCT and the propensity to remove silicone oil were measured. Results: Mean preoperative and postoperative BCVA at final follow up were Log MAR 2.69 (20/9795) ± 0.41 and Log MAR 1.51 (20/647) ±0.90 (p<0.05) respectively in Group A and Log MAR 2.9 (20/15886) and Log MAR 2.37 (20/4688) ±0.86 (p<0.05) respectively in group B. Visual improvement in group A was significantly better than group B (two-sample t-test, p<0.05) with significantly less recurrence of RD (Fisher’s Exact Test, p=0.002). Silicone oil removal was done significantly more in group A (Fisher’s Exact Test, p=0.0017). Conclusion: Sub-silicone oil TA crystals application over sites of RR after 360-degree relaxing retinectomy leads to improved postoperative visual recovery as well as improved anatomical outcomes with fewer complications.

Triamcinolone Acetonide-Loaded Nanoparticles Encapsulated By CD90+ MCSs-Derived Microvesicles Drive Anti-Inflammatory Properties and Promote Cartilage Regeneration After Osteoarthritis

Background: Osteoarthritis (OA) is a highly prevalent human degenerative joint disorder that has long plagued patients. Glucocorticoid injection into the intra-articular (IA) cavity provides potential short-term analgesia and anti-inflammation, but long-term IA causes loss of cartilage content. Synovial mesenchymal stem cells (MSCs) reportedly promote cartilage proliferation and increase cartilage content. Methods: The CD90+ MCSs-derived micro-vesicle (CD90@MV)-coated nanoparticle (CD90@NP) was developed. CD90+ MCSs were extracted from human synovial tissue. Cytochalasin B (CB) relaxed the interaction between the cytoskeleton and the cell membranes of CD90+ MCSs, stimulating CD90@MV secretion. The poly (lactic-co-glycolic acid) (PLGA) nanoparticle was coated with CD90@MV, and a model glucocorticoid, triamcinolone acetonide (TA), was encapsulated in CD90@NP (T-CD90@NP). Results: CD90@MV membrane proteins were similar to CD90+ MCSs, indicating that the CD90@MV bio-activity is similar to the cartilage proliferation-inducing CD90+ MCSs. The CD90@NP binding to injury cartilage primary cells was significantly stronger than the erythrocyte membrane-coated nanoparticles (RNP). In the rabbit OA model, long-term IA of T-CD90@NP showed significantly enhanced repair of damaged cartilage than TA and CD90+ MCSs treatments. In the rat OA model, short-term IA of T-CD90@NP showed effective anti-inflammatory ability similar to TA treatment. Moreover, long-term IA of T-CD90@NP induced cartilage to restart the cell cycle and reduced cartilage apoptosis. T-CD90@NP promotes regeneration of chondrocytes, reduces apoptosis via the FOXO pathway, and influences type 2 macrophage polarization to regulate inflammation through IL-10. Conclusion: This study confirms that T-CD90@NP promotes chondrocyte proliferation and anti-inflammation, improving the clinical glucocorticoid treatment plan.

A Study of Management of Primary Chalazion in Adults by Intralesional Injection of Triamcinolone Acetonide

Introduction A chalazion is a common non-effective granuloma of the meibomian glands of eyelids. They are commonly found on the tarsal conjunctival surface and the eyelid margins. It may be ignored by the patients until it reaches a considerable size. Recently the use of intralesional corticosteroids has shown promising results. We in the present study tried to evaluate the outcomes of intralesional triamcinolone acetonide injection in the management of Chalazion. Methods The current study was carried on Patients with chalazion attending Ophthalmology OPD of Rajiv Gandhi Institute of Medical Sciences, [RIMS], Adilabad. Successive patients with small multiple marginal chalazia were included. Patients were selected based on the amenability of treatment with intralesional triamcinolone acetonide injections. A chalazion is a common non-infective granuloma of the meibomian glands of eyelids. They are commonly found on the tarsal conjunctival surface and the eyelid margins. It may be ignored by the patients until it reaches a considerable size. Recently the use of intralesional corticosteroids has shown promising results. We in the present study tried to evaluate the outcomes of intralesional triamcinolone acetonide injection in the management of Chalazion. Results Group I with very small-sized chalazia< 5 mm out of n=22 included in Group I resolution after one week following treatment was found in 72.72%. Resolution following repeated injection after one week was found in 18.18%. In group II (chalazia size 5-7 mm) out of n=28 cases, 46.24% resolved after first injection and 39.28% cases resolved after the second injection and no resolution was found in 14.28% cases after one month. Conclusion Patients with small chalazia who are not amenable to incision and curettage intralesional triamcinolone acetonide injection appear to be a better option. Intralesional triamcinolone acetonide injections were found to be effective in resolving acute and sub-acute chalazia of soft to firm consistency irrespective of their duration.

HIỆU QUẢ ĐIỀU TRỊ TỔN THƯƠNG MÓNG TRONG BỆNH VẢY NẾN BẰNG TIÊM TẠI CHỖ TRIAMCINOLONE ACETONIDE

Mục tiêu: Đánh giá kết quả điều trị tổn thương móng trong bệnh vảy nến bằng tiêm tại chỗ triamcinolone acetonide. Phương pháp nghiên cứu: Nghiên cứu can thiệp so sánh trước sau trên 79 móng của 11 bệnh nhân vảy nến tại Bệnh viện Da liễu Trung ương từ tháng 8 năm 2020 đến tháng 8 năm 2021. Kết quả: Tổn thương rỗ móng ban đầu là 67 móng, giảm có ý nghĩa thống kê tại tháng thứ 2 với 57 móng (p=0,016) và tháng thứ 4 với 54 móng (p=0,014) tuy nhiên không có sự khác biệt giữa tháng thứ 2 và tháng thứ 4 (p=0,192); các tổn thương rãnh ngang móng, móng xù xì, vạch trắng móng không có sự khác biệt tại thời điểm tháng thứ 2 và 4. Dày sừng dưới móng ban đầu là 61 móng, giảm có ý nghĩa thống kê tại tháng thứ 2 với 52 móng (p=0,031) và tháng thứ 4 với 50 móng (p=0,019) tuy nhiên không có sự khác biệt giữa tháng thứ 2 và tháng thứ 4 (p=0,167); các tổn thương giọt dầu, tách móng, và xuất huyết splinter không có sự khác biệt tại thời điểm tháng thứ 2 và 4. Chỉ số đánh giá độ nặng vảy nến móng (NAPSI) giảm có ý nghĩa thống kê tại thời điểm 2 tháng với mức giảm trung bình 5,1±6,5 (p=0,000) và tiếp tục giảm thêm ở thời điểm 4 tháng với mức giảm so với tháng thứ 2 là 1,5±2,7 (p=0,000). Điểm hoạt động tổn thương móng vảy nến theo Nijmegen (N-NAIL) giảm có ý nghĩa thống kê tại thời điểm 2 tháng với mức giảm trung bình 8,4±8,3 (p=0,000) và tiếp tục giảm thêm ở thời điểm 4 tháng với mức giảm so với tháng thứ 2 là 5,3±6,4 (p=0,000). Tác dụng phụ chủ yếu là tại chỗ gồm teo da, giãn mạch; 33% bệnh nhân nữ có rối loạn kinh nguyệt, không có bệnh nhân nào bùng phát bệnh. Kết luận: Tiêm tại chỗ triamcinolone acetonide là một phương pháp khá an toàn, giúp cải thiện tổn thương rỗ móng và dày sừng dưới móng tại thời điểm 2 tháng và 4 tháng, nhưng không khác biệt giữa 2 tháng và 4 tháng; không làm thay đổi các tổn thương khác. Tiêm tại chỗ triamcinolone acetonide cũng làm giảm điểm NAPSI và N-NAIL cả sau 2 tháng và 4 tháng.

Use of Triamcinolone Acetonide in External Dacryocystorhinostomy

Purpose: To study the effect of Triamcinolone Acetonide injection into the ostium through the external wound after one week of external Dacryocystorhinostomy. Study Design: Quasi experimental study. Place and Duration of Study: Khalid Eye Clinic, Karachi, from July 2018 to June 2019. Methods: This study included forty patients with age ranging between 18 to 36 years. All patients had obstruction of the nasolacrimal duct. Patients were categorized into two groups. Both groups underwent external dacryocystorhinostomy with silicone intubation, with the difference being that patients in group A were injected with 20 units of Triamcinolone acetonide 40 mg/ml into the ostium through wound using 27 gauge needle, one week after the surgery. Group B did not receive any injection. Both groups were followed for a period of four months, at which time the silicone tube was removed and patency of lacrimal system was ascertained via syringing with balanced salt solution through the lacrimal puncta. Main outcome measure was the success rate of procedure. Results: The mean age of the patients was 27.1 ± 5.48 years. Success rate was 100% among the patients of group A and 85% in the patients of group B at the end of the four months followup period. However, the results were statistically insignificant (p = 0.115). Conclusion: Although statistically insignificant but clinically Triamcinolone Acetonide proved helpful in reducing fibrosis and ostium granuloma formation in patients with Ex-DCR. Thus preventing failure of external Dacryocystorhinostomy. Key Words: Triamcinolone acetonide, external dacryocystorhinostomy, DCR.

Comparison of Peri-lesional Triamcinolone Acetonide versus Incision and Curettage in the Treatment of Primary Chalazion

Purpose: To compare the results of peri-lesional Triamcinolone Acetonide (TA) with incision and curettage in the treatment of primary chalazia. Study Design: Quasi experimental study. Place and Duration of Study: Eye department of District Head Quarter/Teaching Hospital, Gujranwala, from June 2018 to May 2019. Methods: One hundred and twenty patients with primary chalazion, either gender and age between 10–30 years, were enrolled in this study. They were equally divided into two groups. In group A, incision and curettage was done. In group B, perilesional TA (40 mg/ml) was given. Followup was done at 5th day, 14th day, 1 month and 3 months. Lesion resolution or recurrence and complications were recorded. IOP monitoring was also carried out at each followup. Results: Mean age was 18.0 ± 2.14 years with range of 10–30 years. There were 45.0% females and 55.0% males. No statistically significant difference was found in age, gender and complication rates between the two groups. Complete resolution was seen in 95.0% in group A and 88.3% cases in group B. The difference between the two groups was not statistically significant regarding small and medium sized chalazia. In case of large chalazia, 23 out of 24 patients in group A and 19 out of 23 patients in group B showed complete resolution and the difference in success rate of two groups was statistically significant (p = 0.014). Conclusion: Incision and curettage and perilesional TA injection are equally effective in treating small and medium primary chalazia. While for large chalazia, Incision and curettage offered superior results. Key words: Chalazion, incision and curettage, triamcinolone Acetonide,

An approach to treatment modalities of keloids: a comparative study

<p class="abstract"><strong>Background:</strong> In spite of the presence of such an array of treatment modalities, none of these can be claimed to be an ideal treatment option as most of them have limited efficacy, significant side effects or increased chances of recurrence. Hence the study was undertaken to search an ideal treatment for keloids which is safe, effective, and with low rate of recurrence.</p><p class="abstract"><strong>Methods:</strong> Total of 200 patients were recruited out of which only 160 patients were included in study. The patients were divided into three groups and administered with different modes of treatment. Patients in all the groups were followed up at 3 weekly intervals for evaluation of response. At the end of the study, the data was compiled and analysed using appropriate statistical tests.<strong></strong></p><p class="abstract"><strong>Results:</strong> In only 32 patients completed study in group 1, 2 and 3 respectively. Group 1, 2 and 3 were more or less equally efficacious with clearance rate. Complete clearance was seen in 24 patients in group 1 patients, in group 2 there were 22 patients with complete clearance and in group 3 there were 24 patients.</p><p class="abstract"><strong>Conclusions:</strong> Intralesional triamcinolone acetonide, intralesional triamcinolone acetonide with hyaluronidase and intralesional radiofrequency with intralesional triamcinolone acetonide are almost equally effective modalities for the treatment of keloids. But, intralesional triamcinolone acetonide with hyaluronidase fares better than other two as far as safety is concerned with least side effects.</p><p class="after-h2"> </p>