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Supratarsal Injection of Triamcinolone in Recalcitrant VKC Dr Suresh K Pandey
Vernal keratoconjunctivitis (VKC) is a severe perennial or seasonal form of allergic conjunctivitis predominantly affecting children and young adults. Eighty percent of patients are below 14 years of age and boys are usually more affected at 2:1 ratio. The chief symptoms of this disease include severe itching, photophobia, redness, tearing and tenacious (ropy) discharge. The important clinical signs in conjunctiva include cobblestone papillae in the upper tarsal conjunctiva, limbal conjunctival thickening with gelatinous nodules and Tranta's dots. Corneal involvement can occur in the form of punctuate keratitis, shield ulcer, scarring and pannus formation.4 In majority of children, the disease resolves spontaneously between age 2 and 10 years. Eyes with refractory and frequently recurrent VKC often develop potentially blinding complications like corneal vascularization, corneal opacity or signs of steroid over use. SUPRATARSAL INJECTION: Triamcinolone acetonide 0.5ml (1 ml = 40 mg drug, Preservative Free sloution AUROCORT) was injected in potential space between conjunctiva and Muller's muscle, 1 mm superior to upper edge of tarsus with a 27 gauge needle after proparacaine hydrochloride 0.5 % was instilled into the eye 3 times at an interval of 2 minutes. This produced ballooning of the potential space between the conjunctiva and Muller's muscle. No eye dressing or patching was used after giving the injection. Topical steroid medications were discontinued & patients were maintened with Olopatadine (Pataday, Alcon Lab.) eye drop once per day for several weeks. The recalcitrant eyes with VKC invariably develop disease related or treatment related complications with irreparable ocular morbidity and blindness. This poses a challenge for the treating ophthalmologist, especially when the patients with advanced VKC remain markedly symptomatic and debilitated despite maximum medical treatment. Supratarsal injection of triamcinolone acetonide in patients with severe refractory VKC, found it well tolerated and provided high rate of clinical response with lack of complications. However, a curative treatment for refractory VKC remains elusive. REFERENCES: Saini JS, Gupta A, Pandey SK, et al. Efficacy of supratarsal dexamethasone versus triamcinolone injection in recalcitrant vernal keratoconjunctivitis. Acta Ophthalmol. Scand. 1999;77:515-518. Pandey SK, Saini JS, et al. Mitomycin-C and vernal conjunctivitis. Letter to the editor. Ophthalmology. 2000;107:2125-2126. CONTACT DETAILS: Dr. Vidushi Sharma, MD (AIIMS), FRCS (UK) Dr. Suresh K Pandey, MS (PGIMER), ASF (USA) SuVi Eye Hospital & Research Centre, Kota, Rajasthan, INDIA Phone +91 744 2433575, +91 9351412449 E-mail: suvieye@gmail.com, www.suvieye.com For Eye Doctors/Ophthalmologists: We offer various hand-on training courses at SuVi Eye Institute, C 13 Talwandi, Kota, Rajasthan, India. For details please contact suvieye@gmail.com Website: www.suvieye.com; phacolasiktraining.com; Phone +91 9351412449, Phaco Training India, Lasik Laser Training India, Hand on Basic and Advanced Phaco Training India, Customized Lasik Refractive Surgery Training India, Training in Oculoplastic Surgery India, Retinal Lasers Training India, Dr Suresh K Pandey Kota India, Dr Vidushi Sharma Kota India, SuVi Eye Institute Lasik Laser Center Kota India, Medical Retina Training India, Dacryo-Cysto-Rhinostomy (DCR) Training India, C3R (Corneal Collagen Cross Linking with Riboflavin) for Keratoconus Training India, Suture-less Glue Free Pterigium Surgery Training India, Botulinum Toxin Training India, Pediatric Cataract Surgery Training India, Intravitreal Injection Training India, Glaucoma Surgery Training India, Strabismus Surgery Training India, SICS (Small Incision Cataract Surgery)Training India, Manual Phaco Training India, Training in Premium IOL (Multifocal, Toric, Accommodative) India, Phakic IOL, Implantable Contact Lens (ICL) Training India, Keratoprosthesis training India.
Intravitreal Injection of Triamcinolone Acetonide Dr Suresh K Pandey SuVi Eye Institute Kota India
This video illustrate Intravitreal Injection of Triamcinolone Acetonide (IVTA) performed by Dr Suresh K Pandey at Suvi Eye Institute, Kota, India. The procedure of IVTA should be carried out with meticulous aseptic precaution, preferably in the operating room. It is very easily carried out under topical anesthesia. A pre-injection single drop of Povidone-Iodine (5%) solution is applied to the eye followed by thorough cleaning of the eyelashes and application of a lid speculum. 0.5% proparacaine hydrochloride drops are applied topically. Alternatively, one could also apply cotton tip pledgets soaked in lignocaine hydrochloride (4%) to the injection site for a couple of minutes prior to the injection to decrease the discomfort. Preservative free triamcinolone acetonide in a single-use bottle (40 mg/ml, 1ml bottle, Aurocort, Aurolab, Madurai, India), is drawn into a 1-cc tuberculin syringe after cleansing the top of the bottle with an alcohol wipe. A separate 27 or 26 gauge needle is placed onto the syringe, which is then inverted to remove air bubbles. The excess triamcinolone is discarded till 0.1 ml (4 mg) remains in the syringe. The injection site is usually the inferotemporal quadrant to avoid drug deposition in front of the visual axis. The stab is given 3 mm from the limbus (in aphakic and pseudophakic patients) and 3.5 mm from the limbus in phakic patients to ensure against passage of the needle through the vitreous base. The needle is usually not introduced all the way to the hub. Using a single, purposeful continuous maneuver, the steroid is injected into the eye. The needle is removed simultaneously with the application of a cotton tipped applicator over its entry site to prevent regurgitation of the injected material. Indirect ophthalmoscopy to check for central retinal artery (CRA) pulsation and paracentesis (if CRA pulsation is present or the globe feels very tense) are carried out, a drop of topical antibiotic solution is administered and the eye is patched. The patient is usually put on a post-injection course of topical antibiotic eye drops for a week. About Dr Suresh K Pandey- A medical graduate of Rani Durgawati University, Medical College, Jabalpur, M.P., India; Dr. Pandey completed his residency in Ophthalmology from prestigious Postgraduate Institute of Medical Education and Research, Chandigarh, India. He worked in University of Utah, USA & University of Sydney, Australia from1998 to 2006. Dr. Pandey returned to India in 2006 to establish SuVi Eye Institute and Research Cente at Kota, Rajasthan, India (www.suvieye.com). Dr. Pandey has presented more than 150 scientific papers in various international ophthalmological meetings and authored more than 100 scientific papers/communications, 50 textbook chapters, and 10 ophthalmic textbooks. In 2005, Dr. Pandey was invited to demonstrate Live Surgery at international meeting at Milan, Italy. Dr. Pandey received several prestigious awards for his research & surgical innovations, which include Best-of-Show Video Award, Best Poster Award, Best-Paper-of-the-Session Award for the surgical videos, scientific posters and papers in the national and international ophthalmology congresses. Most recently, Dr. Pandey has been selected for Achievement Award by the American Academy of Ophthalmology. Dr. Pandey can be reached at Suvi Eye Institute and Research Center, C 13 Talwandi, Kota, Rajasthan, India; E-mail- suvieye@gmail.com, www.suvieye.com
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Funbact - A Triple Action Cream A Cream is an ideal combination of a broad spectrum Synthetic antifungal agent - CLOTRIMAZOLE; a broad spectrum antibacrerial antibiotic - NEOMYCIN SULPHATE; and a potent topical corticosteroid Formula Clotrimazole U S P.................................. 1 0 % w/w Betamethasone Dipropionate U.S.P....... equivalent to Belamethasone................ 0 05 % w/w Neomycin sulphate U.S.P. .................... 0.5 % w/w Cream base........................................... q.s Preservative Chloroeresol U.S.N.F. ..................... 0.1 % w/w Spectrum of Action FUNBACT-A provides a comprehensive treatment for various inflammatory dermatological disorders superadded with bacterial or superficial fungal infections of the skin. Betamethazone Dipropionate is one of the most potent Topical corticosteroid available and rapidly controls the symptoms such as itching, redness and scaling. Many times the inflammatory skin disorders which respond to topical. Email : jkpabitey@yahoo.com
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