Hipo persistente: una rara complicación de una inyección epidural transforaminal de corticoides / Persistent hiccup: a rare complication of a transforaminal epidural corticoid injection / Soluços persistentes: uma complicação rara da injeção peridural transforaminal de corticosteroide

Se describe el caso de un paciente que instaló un hipo persistente luego de recibir una inyección epidural transforaminal lumbar de corticoides. Se destaca que es una complicación raramente reportada y por ende poco conocida por quienes practican intervencionismo en dolor. Se discuten los posibles mecanismos por los que puede presentarse, se reseña la evolución observada, y se describe el tratamiento instituido. Se señala el impacto que el hipo puede tener sobre la calidad de vida.

The case of a patient who installed a persistent hiccup after receiving a lumbar transforaminal epidural injection of corticosteroids is described. It is highlighted that it is a rarely reported complication and little known by those who practice interventional pain medicine. Possible mechanisms by which it may occur are discussed, the evolution observed and the treatment instituted are reviewed. The impact that hiccups can have on quality of life is pointed out.

Descrevemos o caso de um paciente que desenvolveu soluços persistentes após receber uma injeção peridural transforaminal lombar de corticosteróides. Ressalta-se que é uma complicação pouco relatada e, portanto, pouco conhecida por quem pratica o intervencionismo na dor. Discutem-se os possíveis mecanismos pelos quais pode ocorrer, revisa-se a evolução observada e descreve-se o tratamento instituído. O impacto que os soluços podem ter na qualidade de vida é apontado.

Efficacy of ultrasound guided suprascapular block in patients with chronic shoulder pain: observational, retrospective study / Eficácia do bloqueio do nervo supraescapular guiado por ultrassom em pacientes com dor crônica no ombro: estudo observacional retrospectivo

Abstract Introduction: Painful shoulder syndrome is a frequent condition among the elderly and an important cause of functional disability. As the conservative treatment is not always effective, ultrasound guided suprascapular nerve blockade presents as an important alternative treatment. Objective: To evaluate the efficacy and safety of the use of 0.25% levobupivacaine and 40 mg of triamcinolone in the suprascapular nerve blockade in patients with chronic pain in the shoulder. Methods: A retrospective, descriptive and analytical study of 71 patients submitted to suprascapular nerve infiltration between August 2014 and March 2017. Surveys were carried out to patients before the technique was performed, after 72 hours and at 1, 3 and 6 months. Pain intensity was assessed using a numeric pain scale (NPS). Results: Out of the 71 patients who underwent a blockade of the suprascapular nerve, 81.2% reported a decrease in pain at 72 hours. In the first, third and sixth month, respectively, 89.8%, 76.1% and 61.8% of the patients presented pain relief. A statistically significant difference (p < 0.001) was verified between NPS and the 4 moments assessed after the technique. 43.7% had total pain remission (NPS = 0) at six months. Global effectiveness of suprascapular nerve blockade was 60.6% and for the subgroup of patients with rotators' cuff patology was 62.2%. No complications were reported regarding the suprascapular nerve block. Conclusion: The results show that ultrasound-guided blockade of the suprascapular nerve using 0.25% levobupivacaine and 40 mg of triamcinolone is a safe and effective treatment in patients with chronic shoulder pain.

Resumo Introdução: A síndrome do ombro doloroso é uma condição frequente entre os idosos e uma causa importante de incapacidade funcional na população em geral. O tratamento conservador nem sempre é eficaz, pelo que o bloqueio do nervo supraescapular guiado por ecografia apresenta-se como uma opção de tratamento válida. Objetivo: Avaliação da eficácia e segurança do uso de levobupivacaína a 0,25% e 40 mg de triancinolona no bloqueio do nervo supraescapular ecoguiado em doentes com dor crônica no ombro. Métodos: Realizou-se um estudo retrospectivo observacional, descritivo e analítico com 71 doentes submetidos à infiltração do nervo supraescapular entre agosto de 2014 e março de 2017. Foram aplicados questionários antes da realização da técnica, após 72 horas; 1, 2 e 6 meses. A intensidade da dor foi avaliada usando a Escala de Avaliação Numérica (EAN). Resultados: Dos 71 doentes submetidos ao bloqueio do nervo supraescapular; 81,2% referiram diminuição da dor às 72 horas. Aos primeiro, terceiro e sexto mês, respectivamente 89,8%; 76,1% e 61,8% apresentaram melhoria da dor. Verificou-se uma diferença estatisticamente significativa (p < 0,001), entre a EAN inicial e os 4 momentos após a realização da técnica. 43,7% dos doentes tiveram remissão total da dor (EAN = 0) aos seis meses. A eficácia global do bloqueio do nervo supraescapular foi de 60,6% e, para o subgrupo com patologia da coifa dos rotadores, de 62,2%. Nenhuma complicação do bloqueio do NSE foi registrada. Conclusão: Este estudo mostra que o bloqueio eco-guiado do NSE usando levobupivacaína a 0,25% e 40 mg de triancinolona é um procedimento seguro e eficaz em doentes com dor crônica no ombro.

Efecto antiangiogénico de la triamcinolona asociada a lidocaína con epinefrina de uso odontológico en la membrana alantocoriónica de pollo / Antiangiogenic effect of triamcinolone associated with lidocaine with epinephrine for dental use in chicken chorioallantoic membrane

RESUMEN: El proceso angiogénico se define como el proceso en el que los vasos sanguíneos generan brotes dando como resultado neovascularidad. Un desbalance en el proceso angiogénico contribuye a numerosos desórdenes inflamatorios, infecciosos, isquémicos, inmunológicos y malignos. En el territorio maxilofacial se pueden encontrar patologías neoplásicas benignas de desarrollo local con un marcado componente angiogénico que determinan su crecimiento y agresividad. Sin embargo, existe escasa evidencia de cómo tratarlas en base al control de la angiogénesis. Terry & Jacoway (1994) desarrollaron un protocolo de tratamiento para lesiones neoplásicas benignas con un importante componente vascular que se utiliza actualmente. Este protocolo consiste en la infiltración intralesional de una suspensión de triamcinolona 10 mg/ml más una solución de anestésico local de uso odontológico como la lidocaína al 2 % asociada a epinefrina en una concentración de 1:200.000. Sin embargo, el uso de epinefrina podría disminuir la acción antiangiogénica de la triamcinolona al ser un vasoconstrictor. El objetivo de este estudio es comparar el efecto antiangiogénico, en la membrana alantocoriónica de pollo (MAC), de esta suspensión versus el efecto de la triamcinolona sin asociar a anestésicos locales. Los resultados del efecto antiangiogénico en la MAC de pollo, obtenidos en la investigación concluyeron que la suspensión de triamcinolona asociada a lidocaína con epinefrina es similar al de la suspensión de triamcinolona sin asociar a anestésicos locales. Además, se logró determinar que las suspensiones de triamcinolona sin asociar a anestésicos locales y las asociadas a anestésicos locales con o sin vasoconstrictor poseen un marcado efecto antiangiogénico, en la MAC de pollo, en comparación al grupo control.

SUMMARY: Angiogenesis is defined as the process through which new blood vessels form from previously existing vessels. Several inflammatory, infectious, ischemic, immunological and malignant disorders are caused by the lack of adequate angiogenesis balance. In the maxillofacial area, there are invasive benign neoplastic pathologies with a strong angiogenic component, which determines aggressive behavior and growth. Studies in the literature are scarce regarding treatment of these conditions based on angiogenesis control. Currently, the protocol used to treat these maxillofacial benign neoplastic lesions, was developed in 1994 by Terry & Jacoway and has a strong angiogenic component. Consequently lesions are treated via intra-lesion administration of triamcinolone 10 mg / mL, a solution used in dental local anesthetic, such as lidocaine 2 %, in conjunction with epinephrine at a concentration of 1:200,000. The objective of this study was to compare the antiangiogenic effect of this protocol in chicken chorioallantoic membrane (CAM) without the use of local anesthetic. The results of the antiangiogenic effect in the CAM obtained in this study concluded that the effect of the suspension of triamcinolone associated to lidocaine with epinephrine, is similar to the suspension of triamcinolone without associating local anesthetics. Furthermore, it was determined that suspensions of triamcinolone without local anesthetic, and those associated to local anesthetic with, and without vasoconstrictor have a strong antiangiogenic effect in CAM compared to the control group.

Coroidite multifocal / Multifocal choroiditis

Resumo A coroidite multifocal é uma doença inflamatória idiopática pouco comum na prática oftalmológica, que usualmente acomete mulheres jovens. Os autores visam relatar um caso de coroidite multifocal em seguimento ambulatorial em que o paciente foi submetido a injeção subtenoniana de triancinolona associada a corticoterapia via oral com manejo da terapia imunossupressiva. São discutidos os aspectos clínicos, diagnósticos e tratamento. A injeção de triancinolona subtenoniana apresentou bons resultados quando associada à terapia imunossupressiva via oral sobre o edema macular, em consonância com os registros obtidos na literatura médica atual.

Abstract Multifocal choroiditis is an uncommon idiopathic inflammatory ophthalmological disease, which usually affects young women. The authors report a case of multifocal choroiditis in which patient underwent subtenonian triamcinolone injection associated with oral corticosteroid and management of immunosuppressive therapy. The clinical, diagnostic and treatment aspects are discussed. The subtenonian triamcinolone injection presented good results on macular edema when associated with oral imunosuppressive therapy, in agreement with the records obtained in the current medical literature.

Coats disease associated with vasoproliferative tumor treated with cryotherapy and intravitreal injections of triamcinolone / Doença de Coats associada a tumor vasoproliferativo tratada com crioterapia e injeções intravítreas de triancinolona

Abstract Report of a case of Coats disease associated with retinal vasoproliferative tumor in a young female patient with two peripheral vascularized tumors and lipid exudation involving the macula and peripapillary region with serous retinal detachment areas and pre-papillary fibrous proliferation. The proposed and performed treatment was the intravitreal injection of triamcinolone acetonide to decrease the tumor exudation, followed by photocoagulation of the peripheral areas of telangiectasia without subretinal fluid and cryotherapy of the tumors. Despite that this is a rare and difficult to treat combination, in this case report, success was obtained in receding the tumor masses and reapplying the retina, leading to anatomic and visual stabilization.

Resumo Relato de um caso de Doença de Coats associada a tumor vasoproliferativo de retina em uma paciente jovem com duas tumorações vascularizadas periféricas e exsudação lipídica acometendo mácula e região peripapilar com áreas de descolamento de retina seroso e proliferação fibrosa pré-papilar. O tratamento proposto e realizado foi a injeção intra-vítrea de triancinolona para diminuir a exsudação do tumor, seguida de fotocoagulação periférica das áreas de telangiectasia sem fluido subretiniano e criocoagulação dos tumores. Apesar de se tratar de uma associação rara e de difícil tratamento, neste relato de caso, obteve-se êxito em regredir as massas tumorais e reaplicar a retina, levando à estabilização anatômica e visual.

Modulação da cicatrização na cirurgia do glaucoma após aplicação de acetato de triancinolona subconjuntival isolado ou em associação à mitomicina C: estudo experimental / Healing modulation in glaucoma surgery after application of subconjunctival triamcinolone acetate alone or combined with mitomycin C: an experimetal study

RESUMO Objetivo: estudar a eficácia e segurança do uso de acetato de triancinolona subconjuntival isolado ou em associação à mitomicina C como modulador da cicatrização de trabeculectomias em coelhos. Métodos: trinta coelhos machos, albinos, raça Nova Zelândia foram submetidos à trabeculectomia bilateralmente. Os animais foram divididos em quatro grupos experimentais com 15 olhos por grupo: controle, mitomicina C, acetato de triancinolona e acetato de triancinolona + mitomicina C. Tonometria de aplanação e análise clínica da bolha através do Sistema de Graduação de Moorfields foram obtidas no pós-operatório. Para a avaliação da cicatrização, procedeu-se à análise quantitativa do infiltrado inflamatório (polimorfonucleares) através da coloração Hematoxilina & Eosina e da proliferação vascular por imuno-histoquímica. Resultados: foi observada em todos os grupos diminuição significativa da pressão intraocular pós-operatória em relação à pré-operatória (p<0,001). Contudo, não houve diferença entre os grupos (p=0,186). O grupo acetato de triancinolona + mitomicina C apresentou melhores índices na altura máxima da bolha e na vascularização da área central da bolha (p=0,001); além disso, houve menor resposta inflamatória (p=0,001) e menor proliferação vascular (p=0,001) na fase intermediária do estudo em relação às monoterapias. Conclusão: a associação da mitomicina C ao acetato de triancinolona resultou numa ação sinérgica entre esses agentes, com bolhas mais amplas e difusas e menor infiltrado inflamatório e menor proliferação vascular em estágio intermediário do acompanhamento neste modelo animal.

ABSTRACT Objective: to study the efficacy and safety of the use of subconjunctival triamcinolone acetate alone or in combination with mitomycin C as a modulator of trabeculectomy healing in rabbits. Methods: we submitted thirty male, albino, New Zealand rabbits to bilateral trabeculectomy. We divided the animals into four experimental groups with 15 eyes per group: control, mitomycin C, triamcinolone acetate and triamcinolone acetate + mitomycin C. We performed aplanation tonometry and clinical analysis of the bleb through the Moorfields Graduation System in the postoperative period. For the evaluation of healing, we carried out the quantitative analysis of the inflammatory infiltrate (polymorphonuclear) through Hematoxylin & Eosin staining, and vascular proliferation, through immunohistochemistry. Results: we observed a significant decrease in postoperative intraocular pressure in all groups compared with the preoperative pressure (p<0.001). However, there was no difference between groups (p=0.186). The triamcinolone + mitomycin C acetate group presented better indices as for the maximum bleb height and vascularization of the bleb central area (p=0.001); in addition, there was a lower inflammatory response (p=0.001) and lower vascular proliferation (p=0.001) in the intermediate phase of the study compared with the monotherapies. Conclusion: the combination of mitomycin C and triamcinolone acetate resulted in a synergistic action between these agents, with broader and more diffuse blebs, less inflammatory infiltrate and less vascular proliferation in the intermediate stages of follow-up in this animal model.

Análisis de costo-efectividad de ranibizumab comparado con implante intravítreo de dexametasona, triamcinolona, aflibercept y bevacizumab, para pacientes el tratamiento de pacientes con edema macular secundario a oclusión de la vena central de la retina (OVCR) en Colombia / Ranibizumab cost-effectiveness analysis compared to intravitreal implantation of dexamethasone, triamcinolone, aflibercept and bevacizumab, for patients in the treatment of patients with macular edema secondary to central retinal vein occlusion (OVCR

Problema de investigación: Realizar el análisis de costo-efectividad del uso de ranibizumab comparado con aflibercept, implante intravítreo de dexametasona, triamcinolona y bevacizumab para pacientes con edema macular secundario a oclusión de la vena central de la retina en Colombia. Tipo de evaluación económica: Evaluación económica descriptiva de tipo costo-efectividad. Población objetivo: Población con la condición de degeneración macular relacionada a la edad mayor de 50 años en Colombia. Intervención y comparadores: I: Ranibizumab, C: aflibercept, implante intravítreo de dexametasona, triamcinolona y bevacizumab. Horizonte temporal: 24 años. Perspectiva: La del Sistema General de Seguridad Social en Salud (SGSSS). Tasa de descuento: Es de 5% tanto para los costos como para los desenlaces de efectividad. Estructura del modelo: Modelo de Markov de 6 estados con ciclos de 6 meses. Fuentes de datos de efectividad y seguridad: Ensayos clínicos y meta-análisis. Desenlaces y valoración: Años de vida ajustados por calidad (AVAC). Costos incluidos: Costos de medicamentos, Costos de procedimientos e insumos. Fuentes de datos de costos: Consulta a proveedores, SISMED, Manual tarifario ISS 2001. Resultados del caso base: El ranibizumab presenta una efectividad similar, expresada en AVAC, frente a los demás medicamentos antiangiogénicos (bevacizumab y aflibercept). Con respecto al aflibercept, el ranibizumab es una estrategia dominada. Por su parte, al compararlo con bevacizumab, no es una estrategia costo efectiva ya que su RICE supera el umbral de tres PIB per cápita. Análisis de sensibilidad: El ranibizumab es una estrategia dominada en cada uno de los escenarios planteados para las distintas tasas de descuento. El bevacizumab por su parte sigue presentando la mejor costo-efectividad en cada uno de los escenarios, ya que aunque su efectividad es similar, el costo asociado al tratamiento es menor que el de otras alternativas antiangiogénicas. \r\nConclusiones y discusión: Ranibizumab no es una alternativa costo-efectiva comparada con bevacizumab ni con aflibercept. El ranibizumab es costo-efectivo comparado con implante intravítreo de dexametasona y \r\npotencialmente costo-efectivo con triamcinolona.(AU)

Análisis de impacto presupuestal de ranibizumab comparado con aflibercept, triamcinolona y bevacizumab para tratamiento de pacientes con edema macular secundario a oclusión de la vena central de retina en Colombia / Ranibizumab budget impact analysis compared to aflibercept, triamcinolone and bevacizumab for treatment of patients with macular edema secondary to central retinal vein occlusion in Colombia

Tecnologías evaluadas: Intervención: Ranibizumab; Comparadores: Aflibercept, triamcinolona y bevacizumab. Población: Pacientes con edema macular secundario a oclusión de la vena central de la retina en Colombia. \r\nPerspectiva: Tercer pagado - Sistema General de Seguridad Social en Salud (SGSSS). Horizonte temporal: \r\nEl horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente, se reportan las\r\nestimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: Costo de medicamentos; Costos de procedimientos e insumos. Fuente de costos: SISMED; Manual tarifario ISS 2001. Escenarios: Escenario 1: El costo de los medicamentos permanece igual al actual. El uso de bevacizumab sería de 85%, aflibercept sería del 10%, triamcinolona podría ocupar el 15 % restante Escenario 2: tanto el costo de ranibizumab como el de aflibercept se ajustan al valor de bevacizumab. Ante esta situación, la utilización de aflibercept sería del 50%, ranibizumab y bevacizumab tomarían un 22.5% de participación cada uno y triamcinolona el restante 5%. Resultados: El impacto presupuestal total e incremental al que el sistema de salud colombiano estaría incurriendo al incluir los\r\nmedicamentos ranibizumab, aflibercept, bevacizumab y triamcinolona dentro del plan de beneficios para el tratamiento de edema macular secundario a OVCR bajo las condiciones de caso base este valor sería de 25.716 millones de pesos para el primer año de adopción. Para el segundo y tercer año el impacto incremental sería superior a los 6 y 8 mil millones de pesos respectivamente. (AU)

Triancinolona intra-vítrea e clorpromazina retrobulbar como alternativas ao manejo do olho cego doloroso / Intravietrea trianciclone and retotubulbar chlorpromazine as alternative to blind paintful eye manegement

RESUMO Objetivo: O objetivo desde estudo foi avaliar a efetividade da triancinolona intra-vítrea e da clorpromazina retrobulbar como alternativas no manejo da dor ocular em olhos cegos. Métodos: Este foi um estudo prospectivo intervencionista não-randomizado de pacientes com olho cego doloroso não responsivo ao tratamento tópico e sem indicação de evisceração atendidos no Serviço de Oftalmologia do Hospital Governador Celso Ramos no ano de 2010. Após exame oftalmológico e ultrassonografia ocular modo B, os pacientes foram divididos em dois grupos. Pacientes do Grupo 1 possuíam glaucoma intratável e receberam injeção retrobulbar de clorpromazina 2,5ml, e pacientes do Grupo 2 possuíam olhos phthisicos com componente inflamatório e receberam injeção intra-vítrea de triancinolona 0,3ml. Foram realizadas avaliações com 1, 3 e 6 meses após o procedimento e a dor quantificada de forma subjetiva em uma escala de 0 a 10 (sem dor e com o máximo de dor, respectivamente). Resultados: Foram incluídos 38 olhos, sendo 15 no Grupo 1 e 21 no Grupo 2. Houve predomínio do sexo masculino e idade média de 54 anos. A causa mais prevalente de olho cego doloroso foi o glaucoma neovascular. Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram-se eficazes no controle da dor ocular em olhos cegos no período do estudo (p<0,001). Ocorreu uma redução de 77,1% no uso de colírios (p<0,01) após a aplicação das medicações. Conclusão: Tanto a injeção de clorpromazina retrobulbar quanto a de triancinolona intra-vítrea mostraram resultados significativos no controle da dor ocular em olhos cegos, além de uma redução no uso de colírios. A clorpromazina é um medicamento de baixo custo, com melhor perfil de efeitos adversos e mostrou resultados discretamente melhores relação à triancinolona. Possíveis viéses identificados no estudo são o de tempo e seleção.

ABSTRACT Objective: The objective of this study was to evaluate the efficacy of intravitreal triamcinolone and retrobulbar chlorpromazine as alternatives in the management of ocular pain in blind eyes. Methods: This was a non-randomized interventional prospective study of patients with painful blind eye unresponsive to topical treatment and without indication of evisceration treated at the Hospital Governador Celso Ramos Ophthalmology Service in 2010. After ocular examination and ocular B mode ultrasound, patients were divided into two groups. Group 1 patients had intractable glaucoma and received retrobulbar injection of chlorpromazine 2.5ml, and Group 2 patients had phthisics eyes with inflammatory component and received intravitreal triamcinolone injection 0.3ml. Evaluations were performed at 1, 3 and 6 months after the procedure and quantified pain subjectively on a scale from 0 to 10 (no pain and maximum pain, respectively). Results: 38 eyes were included, 15 in Group 1 and 21 in Group 2. There was a predominance of males with a mean age of 54 years. The most prevalent cause of painful blind eye was the neovascular glaucoma. Any retrobulbar injection of chlorpromazine as the intravitreal triamcinolone shown to be effective in the control of ocular pain in the eye blind study period (p <0.001). There was a 77.1% reduction in eye drops (p <0.01) after application of medication. Conclusion: Both the retrobulbar injection chlorpromazine as the intravitreal triamcinolone showed significant results in the control of ocular pain in blind eyes, and a reduction in the use of eye drops. Chlorpromazine is a low cost product, with a better adverse effect profile and showed slightly better results compared to triamcinolone. Potential bias identified in the study are the time and selection.

Pre-tibial myxedema: treatment with intralesional corticosteroid

The pretibial myxedema is a manifestation of Graves' disease characterized by accumulation of glycosaminoglycans in the reticular dermis. The dermopathy is self-limiting but in some cases may cause cosmetic and functional damage. Conventional treatment is use of topical steroids under occlusive dressing, however the intralesional application has shown good results. We present a case of pretibial myxedema treated with single injection of intralesional corticosteroid.

A Case of Ocular Toxocariasis Successfully Treated with Albendazole and Triamcinolon

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.

Detection of calcium pyrophosphate dihydrate crystal deposition disease by dual-energy computed tomography

No abstract available.

Management of recurrent inflammatory choroidal neovascular membrane secondary to Vogt-Koyanagi-Harada syndrome, using combined intravitreal injection of bevacizumab and triamcinolone acetate.

The purpose of this report is to evaluate the efficacy and safety of combined intravitreal injection of bevacizumab and intravitreal triamcinolone acetonide (IVTA) for recurrent inflammatory choroidal neovascular membrane (CNVM). It was a prospective interventional study of a young female, who was a known case of Vogt-Koyanagi-Harada syndrome. She presented with an inflammatory choroidal neovascualar membrane and signs of panuveitis in the right eye. She underwent a complete ophthalmic examination. She was given intravitreal injection of bevacizumab and IVTA at different sites. There was complete regression of CNVM and ocular inflammation within a week. After six months, she had recurrence of CNVM in the same eye, which was treated similarly. There was a complete resolution of CNVM and ocular inflammation after the combination therapy and systemic steroids, until one year of follow-up. No serious systemic or ocular adverse events were noted. Combination therapy appears to be an effective and safe method in the management of recurrent inflammatory CNVM.

Intravitreal triamcinolone for acute branch retinal vein occlusion: a randomized clinical trial

To evaluate the therapeutic effect of intravitreal triamcinolone [IVT] injection for recent branch retinal vein occlusion [BRVO]. In a randomized controlled clinical trial, 30 phakic eyes with recent [less than 10 weeks' duration] BRVO were assigned to two groups. The treatment group [16 eyes] received 4 mg IVT and the control group [14 eyes] received subconjunctival sham injections. Changes in visual acuity [VA] were the main outcome measure. VA and central macular thickness [CMT] changes were not significantly different between the study groups at any time point. Within group analysis showed significant VA improvement from baseline in the IVT group up to three months [P < 0.05]; the amount of this change was 0.53 +/- 0.46, 0.37 +/- 0.50, 0.46 +/- 0.50, and 0.29 +/- 0.45 logMAR at 1, 2, 3, and 4 months, respectively. Corresponding VA improvements in the control group were 0.20 +/- 0.37, 0.11 +/- 0.46, 0.25 +/- 0.58, and 0.05 +/- 0.50 logMAR [all P values > 0.05]. Significant reduction in CMT was noticed only in the treatment group [-172 +/- 202 micro m, P = 0.029] and at 4 months. Ocular hypertension occurred in 4 [25%] and 2 [14.3%] eyes in the IVT and control groups, respectively. A single IVT injection had a non-significant beneficial effect on VA and CMT in acute BRVO as compared to the natural history of the condition. The 3-month deferred treatment protocol advocated by the Branch Vein Occlusion Study Group may be a safer option than IVT injection considering its potential side effects

Reação orbitopalpebral em resposta a injeção subtenoniana profunda de triancinolona: relato de caso / Orbito-palpebral reaction after subtenonian injection of triamcinolone: case report

Relata-se o caso de reação local após injeção subtenoniana profunda de1 ml de suspensão contendo 40 mg de triancinolona, realizada em uma criança de seis anos de idade, portadora de uveíte intermediária. Observou-se edema e eritema das pálpebras superior e inferior, aproximadamente 30 minutos após a injeção. Houve recuperação completa, sem complicações, ao longo das 24 a 48 horas seguintes.

A case of a local reaction related to a subtenonian deep injection of triamcinolone is reported. The patient was a 6 year old child, with intermediate uveitis. Intense edema and erythema of the eyelids appeared approximately 30 minutes after the injection. Complete resolution occurred among 24 to 48 hours after the injection.

The response pattern of intravitreal triamcinolone injection for non-AMD macular edema.

OBJECTIVE: To determine the pattern of functional and anatomical responses after intravitreal triamcinolone (IVTA) for macular edema in diabetic retinopathy, retinal vein occlusion, uveitis, and macular telangiectasia. MATERIAL AND METHOD: A Retrospective interventional study was carried out between January 2004 and July 2006. Thirty-eight eyes from 36 patients who had undergone an IVTA injection for macular edema from etiologies other than age-related macular degeneration (non-AMD macular edema) were included in the present study. Visual improvement and retinal thickness were the main outcomes. Potential complications, including increased intraocular pressure (IOP), intraocular bleeding, and postoperative endophthalmitis were also recorded. RESULTS: The mean pre-operative logarithm of Minimum Angle of Resolution (logMAR) visual acuity (VA) was 1.0 with an average macular thickness of 463.2 +/- 141.4 microns and mean IOP of 12.9 +/- 2.7 mmHg. The macular thickness rapidly decreased in the first week after an injection with a trough at two months (p < 0.001) and began to rise thereafter. The overall VA started to improve significantly at one month and lasted for two months. The IOP significantly increased from the mean baseline during the first two months in 31.6%, which could be controlled only by the medication. No other serious complications were observed. CONCLUSION: IVTA has the potential to improve both functional and anatomical outcomes in non-AMD macular edema. The decrease in macular thickness occurs from one week after an injection but the visual function improves more slowly and has a short-time effect.

Serous Retinal Detachment Following Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection

We report a case of serous retinal detachment following combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in subfoveal choroidal neovascularization (CNV).