Allergic contact dermatitis of the vulva
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Systemic steroids may be needed to treat vesiculoerosive disease or other particularly severe cases of ACD. A common regimen includes 40–60 mg (or 0.5–1 mg/kg) of oral prednisone daily, given as a 14- to 21-day taper. An alternative is to administer 1 mg/kg of triamcinolone acetonide as a one-time intramuscular injection. While this latter option is simpler for the patient and may achieve better compliance, it forgoes the ability to discontinue treatment if adverse effects arise. Intralesional injection of steroids can be useful for thick lesions and patches of deep inflammation that remain unresponsive to topical treatments (41). Triamcinolone acetonide 10 mg/mL can be employed as a 1-mL injection to help thin out a persistent plaque, and another injection may be administered at a future date if necessary. For more of an anti-inflammatory effect, the triamcinolone can be diluted with saline and given as a 3.3-mg/mL injection. This can be repeated every 6 weeks as long as local adverse effects like hypopigmentation and atrophy do not arise.
Antiangiogenic Agents: Intravitreal Injection
Glenn J. Jaffe, Paul Ashton, P. Andrew Pearson in Intraocular Drug Delivery, 2006
Penfold and associates found that triamcinolone acetonide significantly decreased MHC-II expression consistent with immunocytochemical observations that revealed condensed microglial morphology (32). The modulation of subretinal edema and microglial morphology correlated with in vitro observations suggesting that downregulation of inflammatory markers and endothelial cell permeability are significant features of the triamcinolone acetonide mode of action. In another study (31), they investigated the capacity of triamcinolone to modulate the expression of adhesion molecules and permeability using a human epithelial cell line (ECV304) as a model of the outer blood–retinal barrier (BRB). They found that triamcinolone modulated transepithelial resistance of TER and ICAM-1 expression in vitro, suggesting that re-establishment of the BRB and downregulation of inflammatory markers are the principal effects of intravitreal triamcinolone in vivo. The results indicate that triamcinolone has the potential to influence cellular permeability, including the barrier function of the retinal pigment epithelium.
Intravitreal triamcinolone acetonide in macular edema
A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha in Vitreoretinal Surgical Techniques, 2019
Intravitreal triamcinolone acetonide has several side-effects, one of the two most common of which is steroid-induced elevation of IOP.40,84–;88 A prospective, clinical interventional, comparative, nonrandomized study included 260 consecutive patients (293 eyes) receiving an intravitreal injection of 20–25 mg triamcinolone acetonide as treatment for diffuse DME, exudative ARMD, retinal vein occlusions, uveitis, or CME.134 IOPs higher than 21, 30, 35, and 40 mmHg were measured in 94 eyes (36.2%), 22 eyes (8.5%), 11 eyes (4.2%), and 4 eyes (1.5%), respectively. Triamcinolone acetonide-induced IOP elevation could be treated by antiglaucomatous medication in all but 3 eyes (1.0%), for which filtering surgery became necessary. About 40% of the eyes developed secondary ocular hyper-tension after intravitreal injection of 20–25 mg triamcinolone acetonide, starting about 1 week postinjection for a few eyes and 1–2 months for most. With this dosage, the increase in IOP lasted about 7–9 months, after which the IOP measurements returned to the normal range without any further antiglaucomatous medication being taken. In a multiple regression analysis, younger age was a significant factor contributing to the triamcinolone acetonide-induced increase in IOP.
Vitreous Humor: Composition, Characteristics and Implication on Intravitreal Drug Delivery
Published in Current Eye Research, 2023
Deepakkumar Mishra, Shilpkala Gade, Katie Glover, Ravi Sheshala, Thakur Raghu Raj Singh
Uveitis, an anti-inflammatory disease of the uvea, the layers of the eye underneath the sclera (ciliary body, iris, and choroid), requires the long-term intravitreal injection of anti-inflammatory agents. Triamcinolone is a synthetic glucocorticoid with anti-inflammatory properties and injected through intravitreal injections to patients unresponsive to topical treatment. A suspension is available in two strengths 40 mg/ml (Kenalog®, Bristol-Myers Squibb Company) and 80 mg/ml (Trivaris®, Allergan).7 Trivaris® is an 80 mg/ml triamcinolone acetonide suspension for intravitreal injection for the treatment of uveitis. Whereas Kenalog® is an injectable TA suspension for intramuscular and intra-articular injection for the ocular diseases sympathetic ophthalmia, temporal arteritis and uveitis. Ocriplasmin (JETREA®, Inceptua) a recombinant form of human plasmin approved in the year 2012 for the intravitreal treatment of vitreomacular adhesion. However, the use of Ocriplasmin has been discontinued due to the observed adverse side effects such as vitreous floaters, eye pain post injection and photopsia.
Adalimumab Treatment in Patients with Vogt–Koyanagi–Harada Disease
Published in Ocular Immunology and Inflammation, 2018
Cristóbal Couto, Ariel Schlaen, Mercedes Frick, Marina Khoury, Matilde Lopez, Erika Hurtado, Debra Goldstein
The principles of therapy of VKH disease are to suppress the initial intraocular inflammation with early and aggressive use of systemic corticosteroids for prolonged periods, often initially administered either orally or intravenously.12 Systemic corticosteroids therapy is continued for prolonged periods,13 often accompanied by systemic immunomodulatory therapy during months to years. This treatment may also be supplemented with intravitreal injections of triamcinolone.14 Corticosteroids are well known for their significant number of systemic and ocular side-effects, which include hypertension, diabetes mellitus, infection, osteoporosis, hyperlipidemia, atherosclerosis, glaucoma, and cataracts. Therefore, in patients with chronic ocular inflammation who require high maintenance doses of corticosteroids, conventional immunosuppressive therapy is recommended. Conventional immunosuppressive therapy include antimetabolites (methotrexate, azathioprine, and mycophenolate mofetil), alkylating agents (chlorambucil and cyclophosphamide), and antibiotics (cyclosporine and tacrolimus). In spite of the fact that most of these kinds of drugs can be used in the long term with a better tolerance than corticosteroids, a broad spectrum of side-effects should be taken into account and monitored: exacerbation or reactivation of infections, hematological disturbances, renal and/or liver toxicity, and malignancies.15
The physiologic and pathologic effects of pregnancy on the human visual system
Published in Journal of Obstetrics and Gynaecology, 2019
Dimitrios Kalogeropoulos, Velota CT Sung, Minas Paschopoulos, Marilita M. Moschos, Panagiotis Panidis, Chris Kalogeropoulos
Triamcinolone appears to be safe in pregnancy. At present, there is still inadequate data about the use of anti-VEGF agents and their effects on foetal development. According to a few reports, there were no noxious effects recorded on the foetus after administrating an overall of 6 intravitreal anti-VEGF injections to the mothers’ eyes (Tarantola et al. 2010; Sullivan et al. 2014; Polizzi et al. 2015; Polizzi and Mahajan 2015). However, taking into consideration the theoretical risks to the foetus and the lack of solid data, it is recommended that the use of anti-VEGF agents must be restricted to the cases where their administration is absolutely necessary. Ideally, clinicians should consider performing a pregnancy test in patients of childbearing age before injecting intravitreal anti-VEGF factors (Rosenthal and Johnson 2018).
Related Knowledge Centers
- Asthma
- Cataract
- Glucocorticoid
- Intramuscular Injection
- Osteoporosis
- Inhalation
- Chronic Obstructive Pulmonary Disease
- Skin Condition
- Rheumatism
- Oral Administration