Squint Free Papers - aioseducation

Squint Free Papers
progression of the disease with resulting variable ocular motility and instability
of disease status makes surgical management tricky and warranting frequent
resurgeries.
Triamcinolone has been variously used intravitreally, sub- tenon or sub
conjunctivally by ophthalmologists to treat different inflammatory conditions.
Previous studies have reported the improvement of TRO with orbital injections
of methylprednisolone and triamcinolone. 1 This study aims to identify the role
of triamcinolone acetonide injections on strabismus due to TRO as an option to
the above mentioned modalities without associated adverse effects.
MATERIALS AND METHODS
Ten patients with stable restrictive strabismus following TRO presenting to the
squint clinic, Guru Nanak Eye Centre, Maulana Azad Medical College were
included in the study. After informed consent, the patients were evaluated
for ocular motility ( ductions and versions), primary position deviation( PPD)
and anomalous head position (AHP). Diplopia charting was done in 9 gazes
alongwith applanation tonometry, measurement of proptosis with Hertel
exophthalmometer and recording of BCVA for distance and near. Forced
duction testing (FDT) was done in all the cases for rectus muscles.
Peribulbar injections of 20 mg triamcinolone acetonide were given every 2
weeks in 4 doses, 2 injections each in supero-medial and infero-lateral orbits.
Patients were followed after upto 12 weeks and complete examination was
done pre and post treatment. and ocular motility, primary position deviation,
AHP, diplopia evaluation, amount of proptosis was re- evaluated .FDT was
done to assesss the improvement in restriction.
RESULTS
Ten patients with stable restrictive strabismus due to Thyroid related
ophthalmopathy (TRO) were included in the study in the age group of 30 to 62
years. There were 7 women and 3 men. All the patients had a primary position
deviation ranging from 10 to 28 PD. FDT showed restriction in all for elevation,
two had it for adduction and rest had it for all gaze positions. In all cases,
Peribulbar injections of 20 mg triamcinolone acetonide were given every 2
weeks in 4 doses, 2 injections each in supero-medial and infero-lateral orbits.
Post treatment assessment was done at 12 weeks. Restriction was ameliorated
in all with all or no primary position deviation in 4 of 10 patients. AHP was
eliminated in 60% cases. Adverse effects life IOP elevation was not seen in any
patient. Repeated peribulbar injections of Triamcinolone acetonide seems to
be a viable option to strabismus surgery in improving ocular motility, primary
position deviation and anomalous head posture in patients with TRO.
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