Kenalog
Intralesional steroid injection after nerve block anesthesia in the treatment of orofacial granulomatosis.

Sakuntabhai A, MacLeod RI, Lawrence CM.

Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.

BACKGROUND--The facial disfigurement produced by orofacial granulomatosis causes enormous embarrassment. None of the many therapies recommended is reliably successful. Oral corticosteroids cause significant side effects and repeated injections of small quantities of triamcinolone are painful. We have injected large volumes of triamcinolone after numbing the lips using nerve block anesthesia. OBSERVATIONS--Nine patients (six males and three females, aged 10 to 47 years) with orofacial granulomatosis were investigated. No evidence of an allergic cause was found using patch or contact urticaria tests. Eating chocolate produced lip swelling in one man, and his lip shrank in size after avoiding this for 12 months. Five patients, aged 10 to 24 years, were treated with high-volume intralesional triamcinolone injections (3 to 10 mL of 10 mg/mL) after first numbing the lips using infraorbital nerve branch and mental nerve block. After 6 weeks, the lip size returned to normal in four patients and was reduced in a fifth. One patient was injected on four occasions over a 2-year period; in four other patients treated once, lip size remained reduced for over 10 months. CONCLUSION--Intralesional triamcinolone reduces lip swelling in patients with orofacial granulomatosis. Numbing the lips by nerve block anesthesia before triamcinolone injection enables adequate volumes and repeated injections to be given painlessly.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8466220&dopt=Abstract triamcinolone Kenalog



Kenalog
A dose titration of triamcinolone acetonide on insulin-like growth factor-1 and interleukin-1-conditioned equine cartilage explants.

Sandler EA, Frisbie DD, McIlwraith CW.

Equine Orthopaedic Research Laboratory, Colorado State University, 300 West Drake, Fort Collins, Colorado 80523, USA.

REASONS FOR PERFORMING STUDY: Previous in vitro pilot studies have defined a potentially beneficial effect of insulin-like growth factor-1 (IGF-1) and triamcinolone acetonide (TA) on interleukin-1 (IL-1)-conditioned equine cartilage. Furthermore, an optimal dose for IGF-1 treatment alone has been documented previously using the same test system as in the current project. OBJECTIVES: To perform a dose titration of TA on IL-1-conditioned equine articular cartilage explants in the presence of an optimised IGF-1 dose, in order to optimise a triamcinolone concentration for use in combination with IGF-1 for future investigations. METHODS: Cartilage explants were harvested from the distal femur of a normal horse. The effect of a clinically relevant TA dose range was evaluated in the presence of IL-1 and IGF-1 through measurement of proteoglycan (PG) matrix metabolism (synthesis and degradation). RESULTS: TA and IGF-1 in combination inhibited the IL-1-induced release of PG matrix components (glycosaminoglycan or GAG) from the articular cartilage, as well as producing a significant increase in GAG synthesis. CONCLUSIONS: This experiment provided proof of principle that a combination treatment appears to be able to combat the IL-1-induced matrix depletion, while enhancing anabolic metabolism within the articular cartilage. POTENTIAL RELEVANCE: The use of IGF-1 in conjunction with TA in vivo has the potential to provide beneficial anabolic effects not seen with TA alone.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14756373&dopt=Abstract triamcinolone Kenalog



Kenalog
Intraocular pressure after intravitreal injection of triamcinolone acetonide.

Jonas JB, Kreissig I, Degenring R.

Department of Ophthalmology, Faculty of Clinical Medicine Mannheim of the University Heidelberg, Germany. Jost.Jonas ma.augen.uni-heidelberg.de

AIM: To investigate the intraocular pressure (IOP) response after intravitreal injections of triamcinolone acetonide as treatment of intraocular neovascular or oedematous diseases. METHODS: The prospective consecutive non-comparative interventional case series study included 71 patients (75 eyes) with progressive exudative age related macular degeneration (n = 64 eyes) or diffuse diabetic macular oedema (n = 11 eyes), who received an intravitreal injection of 25 mg triamcinolone acetonide. Mean follow up time was 6.86 (SD 2.52) months (range 3.1-14.47 months). RESULTS: IOP increased significantly (p<0.001) from 15.43 (3.26) mm Hg preoperatively to a mean maximum of 23.38 (8.37) mm Hg (range 13-64 mm Hg) postoperatively. An IOP rise to values higher than 21 mm Hg was observed in 39 (52%) eyes. Elevation of IOP occurred about 2 months after the injection. Preoperative predictive factor for the rise in IOP was younger age (p=0.013). It was statistically independent of refractive error, presence of diabetes mellitus, and indication for the injection. In all but one eye, IOP could be lowered to the normal range with topical medication, without development of glaucomatous optic nerve head changes. In the eyes with an elevation of IOP, IOP normalised about 6 months after the injection, without further medication. Eyes undergoing repeatedly intravitreal injections of triamcinolone acetonide showed only an elevation of IOP, if after the first injection a rise of IOP had occurred. CONCLUSIONS: After intravitreal injections of 25 mg of triamcinolone acetonide, an IOP elevation can develop in about 50% of eyes, starting about 1-2 months after the injection. In the vast majority, IOP can be normalised by topical medication, and returns to normal values without further medication about 6 months after the injection.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12488256&dopt=Abstract triamcinolone Kenalog



Kenalog
[Intraocular triamcinolone for diffuse diabetic macular edema]

[Article in German]

Degenring RF, Kreissig I, Jonas JB.

Fakultat fur Klinische Medizin Mannheim der Ruprecht-Karls-Universitat Heidelberg, Universitats-Augenklinik Mannheim. robert.degenring augen.ma.uni-heidelberg.de

BACKGROUND: The aim of the study was to evaluate the effect of an intravitreal injection of triamcinolone acetonide on the visual acuity of patients suffering from diffuse diabetic macular edema. PATIENTS AND METHODS: The prospective, clinically interventional, uncontrolled study included 32 eyes (26 patients) with diffuse diabetic macular edema and received an intravitreal injection of 25 mg triamcinolone acetonide. Visual acuity was 0.12+/-0.08 (min.-max. 0.03-0.3; median 0.1) at baseline. Mean follow-up was 6.8+/-4.3 months. RESULTS: Visual acuity increased to 0.17+/-0.11 (min.-max.: 0.03-0.4; median 0.125) after 4 weeks (p=0.009) and reached a mean maximum of 0.20+/-0.14 (min.-max.: 0.03-0.5; median 0.16) after 8 weeks (p=0.006). Later, visual acuity showed a slow decrease, but was significantly higher than at baseline up to 6 months postoperatively and 26 eyes (81.3%) gained in visual acuity. Ten eyes (31.2%) developed steroid-induced secondary ocular hypertension. CONCLUSION: An intravitreal injection of 25 mg of triamcinolone acetonide may be an option in the treatment of diffuse diabetic macular edema.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15007605&dopt=Abstract triamcinolone Kenalog



Kenalog
Intraocular availability of triamcinolone acetonide after intravitreal injection.

Jonas JB.

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

BACKGROUND: To evaluate the intraocular concentration of triamcinolone acetonide after intravitreal injection. METHODS: The prospective clinical interventional case series study included 17 patients who had received a 20 to 25-mg intravitreal injection of triamcinolone acetonide as treatment for exudative age-related macular degeneration, diffuse diabetic macular edema, or retinal vein occlusions. During a secondary intraocular surgery taking place 4.1 weeks to 25.7 months after the intravitreal injection, aqueous humor samples were obtained. None of the eyes were vitrectomized. RESULTS: In the aqueous humor samples, triamcinolone acetonide was in low, but measurable, concentrations detected up to 1.5 years after the intravitreal injection. Concentrations found in samples obtained during the first 6 months, or 7 to 12 months, respectively, after the injection ranged between 3.0 microg/l and 436 microg/l, and between 0.0 microg/l and 11.2 microg/l, respectively. CONCLUSIONS: After injection of triamcinolone acetonide, triamcinolone can be present in measurable concentrations up to 1.5 years after the application.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15013884&dopt=Abstract triamcinolone Kenalog