Steroid intra-trochlear injection for the treatment of acquired Brown syndrome secondary to trochleitis.

Abstract

PURPOSE:

To evaluate the outcomes of early intra-trochlear steroid injections in patients with acquired Brown syndrome secondary to trochleitis (ABSST).

METHODS:

Retrospective analysis from medical charts of patients diagnosed as affected by unilateral ABSST from January 2008 to June 2015, and treated according to our Institution protocol: intra-trochlear injection of 1ml of triamcinolone acetonide 40 mg/ml is performed under sterile conditions. In cases of no resolution/improvement within 1 month, further monthly injections are performed up to a maximum number of three. Non-responder patients after three injections undergo recession of the superior oblique muscle.

RESULTS:

Thirteen patients were diagnosed as affected by unilateral ABSST, and were included in the analysis (seven F, six M; median age at diagnosis 30.38 ± 25.56 years). The mean time interval from ABSST diagnosis to the first steroid injection was 7.84 ± 5.40 days (range 2-17). After a median number of 1.30 injections per patient, 11 patients (84.6% of the total) showed complete remission of symptoms and signs within 22.45 ± 13.85 days after the first injection. None of these responder patients referred to diplopia in primary gaze after injections. The remaining two non-responder patients after three injections underwent superior oblique muscle recession of 8.0 mm.

CONCLUSIONS:

Early intra-trochlear steroid injections are effective in patients with acquired Brown syndrome secondary to trochleitis, leading to a complete recovery of signs and symptoms in the majority of treated patients. Surgical treatment should be limited only to patients non-responding to serial steroid injections.

• Authors: Giuseppe Giannaccare, Laura Primavera, Chiara Maiolo, Michela Fresina, Emilio C Campos
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 255 Issue 10 Pg. 2045-2050 (Oct 2017) ISSN: 1435-702X [Electronic] Germany
• PMID: 28770346 (Publication Type: Journal Article)

Chemical References

• Glucocorticoids
• Triamcinolone Acetonide

Topics

• Adolescent
• Adult
• Aged
• Child
• Child, Preschool
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Male
• Middle Aged
• Ocular Motility Disorders (diagnosis, drug therapy, etiology)
• Oculomotor Muscles (innervation, physiopathology)
• Retrospective Studies
• Treatment Outcome
• Triamcinolone Acetonide (administration & dosage)
• Trochlear Nerve
• Trochlear Nerve Diseases (complications, drug therapy)
• Young Adult