Pemphigus vulgaris (PV) is a chronic, autoimmune, intraepidermal blistering disease of the skin and mucous membranes. The initial clinical manifestation is frequently the development of intraoral lesions, and later, the lesions involve the other mucous membranes and skin. The etiology of this disease still remains obscure although the presence of autoantibodies is consistent with an autoimmune disease. These antibodies are targeted against the adhesion proteins of keratinocytes, leading to acantholysis (disruption of spinous layer, leading to intraepidermal clefting) and blister formation. Because only oral lesions are present initially, the chances of misdiagnosing the disease as another condition are increased, leading to inappropriate therapy. In this article, we report a case of PV with only oral manifestations in a 36-year-old male.
BACKGROUND The aim is to study and compare supratarsal triamcinolone injection efficacy in respect to conventional modes of topical steroids & cyclosporine in cases of refractory VKC. MATERIALS AND METHODS 78 patients of refractory VKC were randomly distributed in 3 groups of 26 patients each. Topical difluprednate was given in group I, 0.4 mg triamcinolone acetonide was injected in supratarsal area in group II while 0.1% cyclosporine/Tacrolimus was given in Group III. RESULTS 51 (65%) were male while 27 (35%) were female with mean age group of 12.2 ± 3.5 years (Range-7 to 21 years). In group I, large papillae resolved in only 20 (77%) patients of the group while active shield ulcer resolved in 18 (69%) patients. In group II patients, large papillae and active shield ulcer showed marked improvement in 25 (97%) patients. There was significant difference as compared to topical steroids in respect to these signs. In group III patients, symptoms and signs improvement was less when compared to others. Recurrence was seen in both topical steroids and injectable triamcinolone after 3 months in almost 20-30% patients. In cyclosporine treated group, this was as high as 50-60% after 3 months. CONCLUSION Supratarsal injection has better patient compliance and significant improvement in signs over topical steroids although recurrence is almost similar. Prompt IOP monitoring is very important. Cyclosporine can be used in maintenance therapy because of its less side effects though its efficacy is far less than other 2 modes.
To determine the indications, complications, and outcomes of intravitreal triamcinolone acetonide (IVitTA) injection in macular oedema.
METHODSThis retrospective study included 105 eyes of 81 patients who received 4 mg IVitTA for treatment of macular oedema due to different aetiologies between May 2011-October 2012. Recorded were demographic data, best corrected visual acuity, intraocular pressure (IOP), degree of cataract if any, macular thickness (By optical coherence tomography) complications and improvement in visual acuity and macular oedema.
RESULTSShort-term improvement in visual acuity and macular thickness were in 50% patients and long-term outcomes were less promising. Main complications were cataract (61%), increase in IOP (31%).
CONCLUSIONIVitTA remains a promising therapy for patients with macular oedema of different aetiologies refractory to other modalities of treatment at least in short term. It seems relatively safe, but not without complications.
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