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PURPOSE To determine volume fill levels, estimated costs, and force expulsion requirements per bottle of topical ophthalmic steroids commonly used in the United States. SETTING Tertiary care academic referral center. DESIGN Prospective laboratory investigation. METHODS Eight commercially available medications were tested: loteprednol 0.5%, loteprednol gel 0.5%, loteprednol gel 0.38%, difluprednate 0.05%, generic fluorometholone 0.1%, branded fluorometholone 0.1%, generic prednisolone 1.0%, and branded prednisolone 1.0%. Ten bottles of each medication were tested. A double-blinded method was used to measure actual bottle-fill volume and number of drops dispensed per bottle. The total perioperative cost per drop was calculated for each medication using average cash price. Force requirements were measured using a customized force gauge apparatus. Formulations were compared using Kruskal-Wallis one-way ANOVAs. RESULTS All formulations were able to cover postoperative periods commensurate with commonly used dosing regimens for cataract surgery. All medications had greater than sticker volume. Loteprednol 0.5% suspension and branded fluorometholone had the highest and lowest number of drops among the medications tested, respectively. Loteprednol 0.38% gel was the most expensive medication, while generic prednisolone 1.0% was the least expensive. Gel and branded formulations of ophthalmic steroids required less expulsion force compared to other tested formulations. CONCLUSIONS Volume fill levels, patient-incurred costs and expulsion force requirements per bottle of topical steroid medications vary widely. Clinicians may wish to consider these findings when determining their perioperative prescribing regimens.

Purpose Children with high ametropia who have difficulties with spectacle or contact lens wear benefit from gains in visual function after intraocular collamer lens (ICL) surgery. Here we assess safety by reporting rates and case specifics of peri-operative and longer-term adverse events (AE).[LINE SEPARATOR] SETTING:: St. Louis Children's Hospital at Washington University Medical Center. Design Retrospective Case Series. Methods Clinical data were collated retrospectively for 95 special-needs children (160 eyes) implanted with a Visian ICL over the last 5 years. All surgeries were performed at St Louis Children's Hospital under brief general anesthesia. Follow-up was a mean 2.0 ±1.4 years (range 0.5-5.2). Results Average age at implantation was 9.3 ± 5.2 years (range 1.8-25) and mean pre-operative SEQRE was -11.2 ± 3.9 D (range - 4-22). Sixty-two children (65%) had a neurodevelopmental disorder. The minor AE rate was 2% (3 eyes), consisting of steroid-response ocular hypertension (OHT), which resolved with cessation of topical steroid drops. Endothelial cell loss averaged 8.1 % over 2 years, comparable to that reported in ICL implanted adults. The most common major AE (4%, 7 eyes) was post-operative pupillary block, requiring revision of the peripheral iridotomy. One child (0.6%, 1 eye) with self-injurious behavior required repair of a wound leak. One child (0.6%, 1 eye) with Down syndrome developed a cataract 2.8 years after ICL surgery. And one child (0.6%, 1 eye) with severe Autism Spectrum Disorder experienced traumatic retinal detachment 1.2 years after implantation. Conclusion The most common major AE among our Visian ICL cohort was pupillary block due to closure of the iridotomy. Overall, the AE rate was low in this higher risk, difficult-to-manage population of special-needs children.

BACKGROUND In mild psoriasis, topical agents remain the mainstay of treatment. However, the available treatments are not satisfactory for a significant proportion of patients in many terms such as efficacy and safety. Because of these deficits, augmentation of therapeutic effect seems desirable. THIS STUDY AIMS To evaluate the efficacy of topical cyclosporine cream, delivered by fractional CO2 laser vs the efficacy of topical clobetasol cream for the treatment of mild to moderate plaque psoriasis. PATIENTS AND METHODS Twenty-two patients with chronic plaque psoriasis involving

Purpose Radiation dermatitis is one of the most common acute toxicities induced by chemoradiation therapy (CRT) for head and neck cancer (HNC). The benefit of topical steroids in the management of radiation dermatitis is still unclear. This phase 3, multi-institutional, randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of topical steroids for radiation dermatitis in patients with locally advanced HNC receiving CRT. Methods and Materials Eligible patients were scheduled to receive bilateral neck irradiation (≥66 Gy) with concurrent cisplatin (≥200 mg/m2) as definitive or postoperative CRT. Patients were randomly assigned to receive either topical steroid or placebo when grade 1radiation dermatitis was observed or the total radiation dose reached 30 Gy. Basic skin care including gentle washing and moistening in the head and neck region was performed in both groups. The primary endpoint was the frequency of grade ≥2 radiation dermatitis, in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Grading of radiation dermatitis was performed by independent central review using photographs taken weekly. Results A total of 211 patients were enrolled (intention to treat: steroid 101 and placebo 102). The frequency of grade ≥2 radiation dermatitis was not significantly reduced with the steroid (73.3%; 95% confidence interval, 64.6%-81.9%) compared with the placebo (80.4%; 95% confidence interval, 72.7%-88.1%; P = .23), whereas the steroid significantly reduced the frequency of grade ≥3 radiation dermatitis (13.9% vs 25.5%; P = .034). No significant differences in adverse events, including local infection or compliance with CRT, were observed between the groups. Conclusions Topical steroid may reduce the severity of radiation dermatitis in patients with HNC and thus may become an important therapeutic tool in the management of radiation dermatitis.

BACKGROUND In order to successfully treat scabies and to prevent its spread, it is important to identify the factors that can influence the outcome of scabies treatment. OBJECTIVES This study was designed to evaluate the risk factors associated with treatment resistance scabies during use of an effective topical medication. METHODS A retrospective cohort study was performed in patients with scabies infestations confirmed by potassium hydroxide (KOH) examinations. Patient characteristics, clinical features and treatment history were collected. The treatment resistance group included patients with persistent scabies infestations for more than 28 days after initiation of antiscabies treatment with 5% permethrin cream. RESULTS In total, 138 patients with scabies infestations treated between January 2017 and December 2020 were included in this study. Of these, 100 (72.5%) patients were treated successfully, while 38 (27.5%) patients experienced treatment resistance. In the univariable analysis, risk factors for treatment resistance scabies included impaired cognitive function (OR = 2.66, 95% CI, 1.15-6.14), limited mobility (OR = 2.97, 95% CI, 1.30-6.83), inpatient status (vs. outpatient, OR = 3.3, 95% CI, 1.28-8.54), topical steroid use before diagnosis (OR = 3.52, 95% CI, 1.61-7.81), systemic steroid use before diagnosis (OR = 3.57, 95% CI, 1.26-10.34) and a positive KOH exam after the first treatment (OR = 7.25, 95% CI, 3.24-17.11). In the multivariable analysis, limited mobility (OR = 3.46, 95% CI, 1.02-12.11) and topical steroid use before diagnosis (OR = 3.65, 95% CI, 1.41-9.75) were significant predictive factors for treatment resistance scabies. CONCLUSIONS Scabies patients with limited mobility and topical steroid use before diagnosis are at high risk of treatment resistance. Dermatologists should take these findings into consideration when treating patients with scabies infestations.

We examined whether steroid ointment (0.1% dexamethasone) is an effective treatment for mucoceles.Using a retrospective cohort study design, a statistical study was conducted of 91 patients diagnosed with mucoceles at the Department of Dental and Oral Surgery, Saga University Hospital, Saga, Japan, between January 2006 and December 2016. The patients' age and sex; shape, size, and site of the lesion; duration; and treatment response rate were evaluated.The most frequent site of mucoceles was the lower labial mucosa, and several were10 mm in size. The age of onset was often20 years, with no sex-based differences. The treatment response rate was 65.8% for steroid ointment and 100% for surgical removal. In the subgroup analysis according to each clinical factor, some subgroups showed statistically nonsignificant differences compared with the surgery group. Among them, the older age and short disease duration subgroups showed small risk differences, suggesting that application of ointment may lead to a response in these subgroups.Although its response rate was lower than that of surgical removal, topical steroid application is a noninvasive and useful treatment method that can be used for patients in whom surgical treatment is infeasible.

There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.

Background Topical corticosteroid (TCS) phobia is a fear of steroids, most prevalent among the general steroid users, the origin of anxiety and fear about steroids is still unclear. Although multiple studies have been using the validated TOPICOP© scale to assess the scores of steroid phobia in various skin disorders. Objectives The aim of the study was to analyze the steroid phobia among users of topical corticosteroids and also to assess the association between demographical characteristics and TCS phobia. Methods A cross-sectional survey was conducted to evaluate the belief and perspectives of TCS in a large range of patients of both genders of all ages. Patients presenting in dermatology clinic with any dermatological complaint, who were being treated or currently on topical steroids were included. TOPICOP© scale was used to assess the topical steroid phobia. Results A total of 221 topical steroid users were selected for this study, among them 56 (26.7%) were male and 162 (73.3%) were female. The median of global TOPICOP score was 18% and CI 22-12%, S.D: 6.23. The median score of knowledge and beliefs was 7%, (IQR: 9-4%), S.D: 3.33, while fear showed median 5% (IQR: 7-3%), S.D: 2.24, and 6% (IQR: 8-4%), S.D:2.4 for behavior 96 (43.4%). Patients who were not well aware of steroids but still afraid of using steroids. 112 (50.7%) acknowledged the non-adherence to treatment. Conclusion Steroid phobia is more prevalent among uneducated users of topical steroids than among those who are knowledgeable and literate. Healthcare practitioners should counsel their patients about steroids use and related concerns, rather than addressing the issue that is causing fear in patients.

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.

Significance In this report, the authors present a case of a 63-year-old man with recurrent pseudophakic cystoid macular edema. Macular edema was refractory to the treatments with periocular corticosteroid injection and topical anti-inflammatory medications. It was treated with subconjunctival bevacizumab (2.5 mg) injections. Purpose The purpose of this report was to demonstrate the efficacy and safety of repeated injections of subconjunctival bevacizumab in pseudophakic cystoid macular edema. Case report A 63-year-old White man presented with ongoing blurred vision in his left eye 4 months after a complicated cataract surgery. Despite the administration of sub-Tenon triamcinolone in the first-month visit because of cystoid macular edema and the use of topical steroid and nonsteroidal anti-inflammatory medications during the 4 months, there was no change in his vision. The first subconjunctival bevacizumab injection was performed 16 weeks after cataract surgery. The best-corrected visual acuity was significantly improved, and central retinal thickness dramatically decreased after the first injection. Macular edema reoccurred 26 and 46 weeks after cataract surgery. At these relapses, repeated subconjunctival injections of bevacizumab were influential in resolving macular edema and restoration of vision, even in the chronic phase. After 6 months, visual acuity (20/20) and central retinal thickness (274 μm) were stable after four total injections. No drug-related adverse events were observed during the follow-up period. Conclusions The repeated subconjunctival injections of bevacizumab were effective and well tolerated in pseudophakic cystoid macular edema. Subconjunctival bevacizumab may be a safe alternative to intravitreal applications in patients with pseudophakic cystoid macular edema.

Topical corticosteroid phobia may lead to poor adherence, resulting in persistent disease and escalation to systemic agents. The aim of this paper was to review current literature to assess topical steroid phobia prevalence, populations most at risk, reasons behind steroid phobia, and interventions to reduce it. A systematic search of PubMed, Ovid (Journals@Ovid, MEDLINE), ScienceDirect, and Web of Science was performed. Studies ranged from May 2000 to February 2021. In total, 37 articles met the inclusion criteria. There was inter-study variation in the way steroid phobia is defined, from concern to irrational fear. The worldwide prevalence of topical steroid phobia ranges from 31 to 95.7% and does not differ with patient race/ethnicity or dermatological condition. Female patients and caregivers, and those who have experienced side effects of topical corticosteroids are most likely to express steroid phobia. Reasons for steroid phobia include lack of education, fear of side effects, polypharmacy, misinformation, negative experience with topical steroids, and frequently changing of clinics. Successful interventions to address steroid phobia include patient education in the form of educational videos followed by individualized oral education based on concerns, and demonstrations of application of topical steroids. Multiple interventions address topical corticosteroid phobia and improve adherence of topical corticosteroids in the management of dermatological conditions. Providers should screen patients for steroid phobia, especially in populations particularly at risk. Interventions using patient education should be individualized based on concerns expressed during screening. Further research should investigate if reducing steroid phobia can in fact improve long-term adherence.

Objective: to study efficacy and factors of excessive proliferation after trabeculectomy (T) in pediatric uveitic glaucoma (UG).Patients and Methods. 102 children aged from 3 to 17.5 years (mean 124.5 ± 2.8 month) with uncontrolled on maximum topical hypotensive therapy open angle or combined (with peripheral anterior synechiae) form of UG underwent T (148 eyes, 180 operations). 76.1 % operations were performed with intraoperative 5-fluorouracil, 8.3 % — with mitomycin C, 6.1 % — with bioresorbable, 1.7 % — with collagen drainage, 7.8 % — without antimetabolites or drainages. Kaplan-Meier survival analysis was performed.Results. Overall absolute (without hypotensive therapy) success probabilities were 67 %, 46 %, 39 %, qualified success (with hypotensive therapy) — 93 %, 72 %, 54 % at 1, 3, 5 years after T respectively. Factors associated with failure were primary location of inflammation in anterior uvea, aphakic or pseudophakic eye, repeat T, bioresorbable drainage (vs. 5-fluorouracil), persistent inflammation after T. Age and uveitis activity at the moment of T, duration hypotensive therapy before primary T, postoperative complications (9.4 %), frequency of postoperative topical steroid had no significant influence on surgical success.Conclusion. T with intraoperative antimetabolites is effective, safe and nowadays may be recommended as first choice operation in pediatric open angle or combined UG.

The widespread spread of balanoposthitis necessitates the development of highly effective treatment methods. The experience of using combined topic steroid in a patient with balanoposthitis complicated by reactive arthritis and keratoderma is described. The high efficiency of treatment of balanoposthitis and keratoderma with a combined topical steroid with anti-inflammatory, antimicrobial, fungicidal and wound healing effects has been shown.

To evaluate the rise in intraocular pressure (IOP) in post cataract surgery patients who received topical steroids.Patients in the age group of 50-75 years and both sexes who were coming to ophthalmology OPD at a tertiary care hospital of Western Maharashtra were studied. 500 subjects who underwent uncomplicated cataract surgery were taken into consideration; both age and sex matched. All patients were screened for raised intraocular pressure by Perkin’s tonometer preoperatively and at 5th day, 2nd week, 4th week, 6th week and 8th week postoperatively. Patients were allocated into two groups: either topical Prednisolone acetate e/d (1%) (Group I) or Dexamethasone e/d (0.1%) (Group II) started six times for 1st week (considering the cells in anterior chamber In our study group, the prevalence of steroid-responders was 3.6% with 0.8% showing mild rise, 2.8% showing moderate rise in IOP on the fourth week of topical steroid usage. There was no difference in the mean IOP rise with the usage of two different topical steroids (E/d Prednisolone acetate (1%) and E/d Dexamethasone(0.1%)) in our study. The highest mean IOP was noted at the 5th postoperative day (20.26 mmHg) which was due to inflammation & there was a gradual decrease in IOP in the subsequent weeks of follow-up till 8th week. While as duration after cataract surgery progress till 8th week of follow up, moderate rise in IOP occurs which gradually comes down to mild rise till 8th week of follow-up.Steroid-induced IOP elevation typically occurs after 4 weeks of beginning steroid therapy and the prevalence of steroid responders in post cataract surgery patients was established.

Coronavirus disease (COVID-19) can be associated with ophthalmic manifestations like conjunctivitis, retinal haemorrhages, retinal vascular occlusions, papillophlebitis, and Adie's syndrome. We herein report for a case of a unilateral acute anterior uveitis which was quiescent for 13 years and was reactivated post COVID-19 infection in a 43-year-old Asian Indian male. He had a past history of recurrent unilateral granulomatous anterior and intermediate uveitis in the right eye (RE), and all the investigations done 14 years ago were negative and had been on treatment with topical and oral steroids. He developed cataract 6 months later in the RE and underwent surgery. Patient was in remission for the past 13 years. Uveitis investigations for the present episode were all negative. Topical steroid and cycloplegic helped in resolution of the uveitis. This may be the first instance of reactivation of a quiescent unilateral anterior uveitis following COVID-19 infection.

Objective To summarize the recent evidence of traditional Chinese medicine (TCM) for food allergy and eczema. Data Sources Published literature from PubMed database and abstract conference presentations. Study Selections Studies relevant to TCM for food allergy and eczema were included. Results TCM is the main component of complementary and alternative medicine in the United States. Food Allergy Herbal Formula 2 (FAHF-2) (derived from the classical formula Wu Mei Wan) prevented systemic anaphylaxis in murine models and was found to have safety and preliminary immunomodulatory effects on T cells and basophils. The phase II trial of combined TCM with oral immunotherapy and omalizumab for multiple food allergy is ongoing. Retrospective practice-based evidence study revealed that comprehensive TCM therapy effectively prevented frequent and severe food anaphylaxis triggered by skin contact or protein inhalation. The traditional Japanese herbal medicine Kakkonto suppressed allergic diarrhea and decreased mast cells in intestinal mucosa in a murine model. The active compounds from TCM were found to have potent inhibition of immunoglobulin (Ig) E, mast cell activation, and proinflammatory cytokine or signaling pathway (tumor necrosis factor alpha, interleukin 8, NF-κB) suggesting value for both IgE and non–IgE-mediated food allergy. Triple TCM therapy including ingestion, bath, and cream markedly improved skin lesion, itching, and sleep loss in patients with corticosteroid dependent, recalcitrant, or topical steroid withdrawal. Xiao Feng San and Japanese and Korean formulas were found to have effectiveness in eczema. Furthermore, acupuncture reduced wheal size, skin itching, and basophil activation in atopic dermatitis. Moreover, TCM is generally safe. Conclusion TCM has potential as safe and effective therapy for food allergy and eczema. Further research is needed for botanical drug development and to further define the mechanisms of actions. Trial Registration FAHF-2: https://ichgcp.net/clinical-trials-registry/NCT00602160 ; ethyl acetate and butanol purified FAHF-2: https://clinicaltrials.gov/ct2/show/NCT02879006 .

Five cases (one male, four females aged between 32-65 years) of acute painful red eye following application of steroid eye drops have been presented. Their presentation followed a similar trend viz: sudden painful eyes, redness, tearing, photophobia, tenderness, and blepharospasm following topical steroid eye use. There was immediate relief within an hour of instillation of atropine 1% eye drop and full recovery after two weeks of presentation following further treatment with atropine 1% eye drop, tablet paracetamol, chloramphenicol eye drop and flurbiprofen eye drop. Steroids are important group of drugs that are employed in the management of many medical conditions. When used properly, they bring good results most of the time. Acute red eye was observed in this case series following topical steroid use on the eyes and the patients need to be educated on the proper use of this group of drugs so as to reduce its adverse effects.

Topical corticosteroid’s anti-inflammatory action is the common property that induces the misuse of the topical steroids. Most of the time, even a medical graduate is misguided about the steroidal molecules in the combination formulation for the treatment of infections which gives temporary relief of symptoms such as itching and lightening effect in short term, But on long term will lead onto local adverse reactions such as dryness, burning sensation and striae etc.To analyse the knowledge of the medical students towards topical steroids and bridges the gaps in the knowledge.6 semester students who gave consent for the inclusion in the study were enrolled and a pretested validated questionaries were given to be filled. After the pretest, a video presentation of the topic was presented and the post test was given with the same format after 3 months. Results were analyzed using SPSS software.75% of the students heard about the topical steroids, out of which 57% were irrelevant steroid combination and 36% were Kligman’s formula. On comparing the pre and post test results, there is significant increase in the awareness regarding long term use of topical steroids (PPrecise and adequate knowledge regarding topical steroid should be initiated in the early clinics in undergraduate curriculum and should be propagated or reinforced throughout the curriculum to prevent the misuse of topical steroids.

Jacob Larsen,1 Travis Whitt,2 Briana Parker,1 Russell Swan3,4 1Clinical Research, Vance Thompson Vision, Bozeman, MT, USA; 2Department of Optometry, Vance Thompson Vision, Bozeman, MT, USA; 3Department of Ophthalmology, Vance Thompson Vision, Bozeman, MT, USA; 4Ophthalmology Moran Eye Center, University of Utah, Salt Lake City, UT, USACorrespondence: Jacob LarsenClinical Research, Vance Thompson Vision, Bozeman, MT, USATel +1 406-544-2140Fax +1 406-624-6560Email Jacob.larsen2020@outlook.comPurpose: To determine patient preference and treatment outcomes with an intracanalicular dexamethasone (0.4 mg) insert compared to standard steroid drop regimen in the contralateral eye following bilateral RLE surgery.Methods: This is a prospective, open-label, interventional, randomized, controlled study in 20 subjects who underwent bilateral RLE. Each patient served as their own control with one eye randomized to the intracanalicular insert (Group A) placed at the time of surgery and the contralateral randomized to topical corticosteroid drops (Group B). All eyes received intracameral moxifloxacin at the time of surgery, and post-operatively, topical moxifloxacin QID for one week and topical NSAID daily for four weeks. Post-operative evaluations were performed on Day 1, Week 1, and Week 4– 8.Results: Twenty patients participated. At 4– 8 weeks post-operation, 90% of patients evaluated with the COMTOL questionnaire preferred the intracanalicular insert while 10% preferred the topical steroid. Comparative analysis using the visual analog scale showed no difference in pain between the study and control group. No statistical difference was shown in post-operative corneal staining, anterior chamber cell count, anterior chamber flare or intraocular pressure. Mean LogMAR UCVA at 4– 8 weeks post-operation was 0.06 (± 0.230) in the study group and 0.065 (± 0.241) in the control group, which was not statistically or clinically different (p > 0.05).Conclusion: Patients undergoing bilateral RLE expressed a strong preference towards the use of an intracanalicular insert over a topical steroid for post-operative steroid treatment. There was no clinically or statistically significant difference in outcomes, including rate of cystoid macular edema, visual acuity and elevation of intraocular pressure.National Clinical Trial Number: 04549935.Keywords: punctal plug, steroid, visual acuity, cystoid macular edema, patient preference

Background Psoriatic arthritis (PsA) can manifest in various forms. This includes mimicry of other diseases. We describe an unusual mimicry of PsA. Case presentation We report a case of a middle-aged lady who presented with severe pain and morning stiffness over the small joints of the left hand for 3 months and painless deformity of the affected joints 1 year before. She was under treatment for pruritic rash over her ankles and knees for the past 1 year as well. Physical examination revealed a fixed flexion deformity, swelling and tenderness of the left ring and little fingers’ distal interphalangeal (DIP) joints. Left hand radiograph showed sclerotic joint margin, narrowed joint space and marginal osteophytes of the affected DIP joints. Dermoscopic examination showed red- violaceous, flat-topped papules and plaques with minimal scales on both ankles; hyperpigmented scaly plaques over both knees and vertical fingernail ridges. Serum autoimmune screening and inflammatory markers were unremarkable. Left ankle skin biopsy showed features consistent of psoriasis. PsA was diagnosed. Weekly titrated oral methotrexate and topical steroid were started. The patient showed significant improvement after 1 month of treatment. Conclusion PsA is a great mimicker. Dermoscopy is an accessible and valuable tool to assess skin lesions in greater detail. Clinicians should be aware of coexisting diseases or misdiagnosis when patients do not respond to treatment.

Alopecia areata is a common cause of nonscarring alopecia, with patchy, confluent or diffuse patterns, involving mainly the scalp and other hairy areas of the body. It's considered a therapeutic challenge due to prognosis, unpredictable course and variable efficacy of available therapies. Several studies have evaluated the efficacy of cryotherapy in the treatment of alopecia areata with varying success rates.Superficial cryotherapy using liquid nitrogen mainly was used in several studies for treating alopecia areata with various subtypes including mild, moderate and recalcitrant alopecia areata, and alopecia totalis with variable rates of therapeutically accepted terminal hair regrowth. Its main mechanisms of efficacy in alopecia areata are vascular changes and immunomodulation. Superficial cryotherapy was effective and safe in treating alopecia areata of the eyebrows. It was nearly as effective as topical steroids and topical PUVA therapy, and was combined with topical immunotherapy and topical steroid with increased efficacy. It's well-tolerated, convenient and simple office-based procedure, especially in children who are susceptible to side effects of other conventional therapeutic options.The reported side effects of superficial cryotherapy included vesiculation, erosion, crust formation, transient pigmentary alteration and partial leukotrichia, however they were transient. Key words: alopecia, cryotherapy, liquid nitrogen

Background Dermatologic toxicity is a very common immune-related adverse event (irAE) for patients with melanoma who are receiving immune checkpoint inhibitor therapy (ICI). Concurrent skin infection, such as in the case of pityriasis versicolor reported here, can mimic and/or exacerbate dermatologic toxicity from irAE. Case presentation A 58-year-old Caucasian man with a history of pityriasis versicolor infection and metastatic melanoma received ICI therapy. He developed progressively worsening pruritic maculopapular lesions 22 weeks into his treatment that ultimately covered 40% of his body. He was diagnosed with dermatologic toxicity due to ICI therapy with concurrent pityriasis versicolor. He was initially started on topical steroid and topical antifungal cream but achieved minimum improvement. His treatment was then escalated to oral prednisone, but it only achieved modest control of his dermatitis. All subsequent attempts to wean him from oral prednisone resulted in worsening of his dermatitis. Eventually he was started on oral fluconazole in combination with prednisone, which led to rapid resolution of his dermatitis. Conclusion We report a case of dermatological toxicity due to an irAE with concurrent pityriasis versicolor. The steroid treatment for irAE was likely exacerbating the underlying fungal infection, and the fungal infection was in term mimicking the symptoms of irAE. This patient’s severe dermatitis was only brought under control after receiving a more potent antifungal therapy in combination with a steroid. It is vital to look beyond the irAE when managing dermatitis in patients receiving ICI therapy.

Relevance.Lichen planus is a chronic recurring dermatosis, characterized by unspecified etiopathogenesis, a variety of trigger factors, a severe, often permanent course, a tendency to malignancy of the lesion elements, and often refractory to the treatment. The most difficult clinical problem is the search for effective methods of treating continuously recurring severe forms of lichen planus and red border of the lips, refractory to corticosteroids. Objective – to improve the quality of treatment for severe forms of lichen planus of the oral mucosa and red border of the lips based on the use of various physical methods in complex therapy.Materials and methods.Depending on the complex of medical procedures, all patients were divided into four groups, the patients of which respectively underwent traditional drug treatment; complex treatment using ozone therapy; complex treatment using photophoresis of red LED radiation and a topical steroid, as well as complex treatment using combined physiotherapy and ozone therapy in combination with photophoresis.Results.The inclusion of physical methods in the complex treatment of patients with severe forms of lichen planus of the mucous membrane of the mouth and lips made it possible to accelerate the time of epithelization of erosive-ulcerative elements and achieve a stable remission of the disease.Conclusion.The obtained clinical data allowed us to draw conclusions about the appropriateness of using physical methods in the treatment of severe forms of lichen planus of the oral mucosa and lips using the effectiveness of combined physiotherapy.

Wolf's isotopic response refers to the occurrence of a novel skin disease at the site of a preceding treated or untreated skin disease. Although the most common preceding skin disease was found to be herpes zoster (HZ), HZ-related dermatological phenomena are not well known in the literature. We report a case of HZ granulomatous dermatitis in a 77-year-old female with a previous history of hypertension, diabetes mellitus, chronic kidney disease, and HZ. She presented with a 3-month history of a pruritic skin lesion on her right thigh. The location of the lesion was consistent with a previous HZ site. Histopathological examination revealed lympho- histiocytic infiltration in the superficial dermis, forming a granulomatous structure. Based on clinical and histopathological findings, we made a diagnosis of granulomatous dermatitis at a previous HZ site. We assumed that the lesion arose from an isotopic response of Wolf. The patient was treated with topical steroids for 3 months and showed clearance of the lesion and symptom. We suggest that treatment should be based on the individual disease, which in our case was topical steroid.

Background Topical corticosteroids alone or in combination with other therapies are widely used to treat mycosis fungoides (MF), but data on response rates to their use as monotherapy in MF are limited. Objective To evaluate the efficacy of topical corticosteroid monotherapy in MF; compare sex, age, stage distributions, and histopathologic features between responders and nonresponders. Methods A retrospective cross-sectional review of patients with MF from 2013 to 2019 treated at Thomas Jefferson University was conducted. Patients with biopsy-proven MF, all stages, who received topical corticosteroid monotherapy were included. Response rates were determined by percent change in body surface area (BSA) involvement and modified Severity-Weighted Assessment Tool (mSWAT). Results Of the 163 patients with MF in our database, 23% (37/163) initially received topical steroid monotherapy. Of these, 73% (27/37) improved, with an average 65% decrease in BSA (67% in mSWAT); 27% (10/37) did not respond/progressed, with an average 51.6% increase in BSA (57% in mSWAT); and 33% (12/37) had a complete response (BSA, 0%) with prolonged topical steroid use. Early-stage MF and female sex were more represented in responders. Limitations Single-center retrospective design. Conclusions Topical steroid monotherapy in early-stage MF can produce measurable improvements in BSA and mSWAT scores and achieve complete remission in a limited subset of patients.

Objectives To evaluate the functional and anatomical results of patients with non-infectious intraocular inflammation (IOI) following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection for the treatment of neovascular age-related macular degeneration (nAMD). Materials and methods The medical records of patients receiving anti-VEGF treatment for nAMD between January 2015 and March 2019 were retrospectively analyzed. Preoperative and postoperative routine ophthalmological examinations, central macular thickness, duration of inflammation, and follow-up time of the patients with non-infectious IOI following anti-VEGF injection were recorded. Results Non-infectious IOI was determined in 13 eyes (11 eyes with aflibercept, 2 eyes with ranibizumab) of 1,966 patients who received a total of 12,652 anti-VEGF (4,796 aflibercept and 7,856 ranibizumab) injections. IOI was detected after a mean of 7 injections (2-12 injections). All eyes had both anterior chamber reaction (Tyndall +1/+3) and vitritis (grade 1-3). None of the patients had pain, hypopyon, or fibrin reaction. Visual acuity progressed to baseline levels within 28.3 days. Vitritis continued with a mean of 40 days. All patients recovered with topical steroid therapy. In 11 eyes, injection of the same anti-VEGF agent was continued. No recurrence of IOI was observed in any patients. Conclusion Non-infectious IOI following intravitreal anti-VEGF injection typically occurs without pain, conjunctival injection, hypopyon, or fibrin and responds well to topical steroid therapy. Visual acuity returns to baseline levels within weeks according to the severity of inflammation.

This article reviews in detail the merits and unique nature of this combination lotion and also discusses a new type of strategy for treating psoriasis topically. The combination lotion proved much more efficacious than the vehicle. Moreover, when the combination lotion was compared head-to-head with each of the components alone (halobetasol, tazarotene) and vehicle lotion, the combination was clearly more efficacious after 8 weeks. In terms of safety, the combination lotion was well tolerated by the patients. The combination lotion is also unique in that it is the only superpotent topical steroid with long-term safety data of 1 year. Now that the FDA has approved a superpotent topical steroid containing a topical agent for unlimited “intermittent” use, compliance and treatment efficacy can be greatly improved. Due to this, the combination lotion can greatly enhance topical therapy for psoriasis and make maintenance therapy practical.

Tinea imbricata and tinea pseudoimbricata are variant types of tinea corporis characterized by annual-ring-shaped erythema. Although the skin lesions manifest similar symptoms, these two diseases are classified based on causative fungi. The former is caused by Trichophyton concentricum, an anthropophilic dermatophyte, and the latter is caused by dermatophytes other than T. concentricum, commonly zoophilic fungi such as Trichophyton mentagrophytes complex. Here, we report a 27-year-old Japanese male diagnosed with tinea pseudoimbricata attributed to Trichophyton tonsurans, an anthropophilic dermatophyte. We suspected that application of steroid ointment caused the annular pattern of his skin lesions. After three months use of topical luliconazole cream, treatment was finished. We also summarize the knowledge about tinea pseudoimbricata through previous reports with bibliographical consideration.

Background: The present study was aimed to measure the salivary level of IL-17 in patients having atrophic and erosive Oral lichen planus lesions (OLP) and to evaluate the effect of topical corticosteroids used for treatment of erosive/atrophic oral lichen planus on the level of IL-17 in the saliva. Subjects and methods: The present study was performed on 40 subjects divided into 3 groups Group (I) Twenty patients diagnosed with erosive/atrophic OLP received topical steroid (triamcinolone acetonide0.1%) four times per day for four weeks. Group (II) Ten patients diagnosed with reticular OLP and Group (III) Ten patients with normal mucosa (healthy control Group). Salivary samples were collected before and after treatment in group (I) and once from subjects in group (II) and (III) for determination of IL-17 levels using enzyme-linked immunosorbent assay (ELISA). Results: The mean IL-17 levels in saliva of erosive/atrophic OLP group were statistically significantly higher before treatment with topical steroid than after treatment and both are statistically significantly higher than the reticular group and healthy control subjects. Also, the clinical score and pain visual analogue score values were statistically significantly higher in the erosive/atrophic group before treatment than after treatment. Conclusions: The salivary levels of IL-17 in erosive/atrophic OLP patients was higher than the reticular OLP patients and both are higher than the healthy control subjects, suggesting that IL-17 has a major role in the pathogenesis of OLP and its salivary level may be diagnostic for the severity of the condition of the erosive/atrophic OLP.

Aim: This study aimed to determine the clinical efficacy of the combination of microbiomes and 0.2% topical hyaluronic acid gel, alongside topical monotherapy with 0.2% hyaluronic acid gel and steroids, respectively, in minor aphthous ulcer management. Subjects and Methods: A total of 45 patients were divided into three groups: Group A (n = 15) –– a combination of microbiome therapy––pre- and probiotics capsules p. o. and topical 0.2% hyaluronic acid gel; Group B (n = 15)––topical 0.2% hyaluronic acid gel; and Group C (n = 15)––0.1% triamcinolone acetonide oromucosal paste. Numerical rating scale (NRS) for pain, ulcer dimensions measured by Digital Planimetry using android mobile application to determine the degree of ulcer healing (%) and occurrence of new ulcers were recorded on 0, third, and seventh days of treatment. Statistical Analysis Used: One-way ANOVA with post hoc Tukey test among the groups and independent t - test for the degree of ulcer healing between third and seventh days were applied. Results: NRS for pain at day 3 showed a statistically significant pain reduction in Group A compared with Groups B and C (P = 0.04, 0.01, respectively). Though Group A showed the highest grade of closure (93.4 ± 2.5%) and a greater decrease in mean NRS score (0.2 ± 0.42) on the seventh day when compared to Groups B and C, results were not statistically significant (P > 0.05). Conclusion: Microbiome and topical hyaluronic acid gel combination therapy helps in immediate pain relief and faster healing. Hence, it could be an excellent alternative for topical steroid management.

Background and Objective: Oral submucous fibrosis (OSMF) is a juxtraepithelial inflammatory reaction followed by fibro elastic change of lamina propria. Hence, the inflammation is a definite component of OSMF. Combinations of turmeric, Aloe vera, and honey have antioxidant and anti-inflammatory effects which may act synergistically to serve as beneficiary for treating OSMF disease. Hence, the present study aims to compare the efficacy of topical application of novel gel containing curcumin, Aloe vera, honey, and physiotherapy with 0.1% triamcinolone acetonide and physiotherapy in the reduction of clinical signs and symptoms of OSMF patients. Materials and Methods: A total of 20 clinically diagnosed OSMF patients were divided into two groups containing 10 patients each. Participants including in Group A were treated with topical application of novel gel-containing curcumin, Aloe vera, and honey along with physiotherapy. Group B patients were treated with the topical application of 0.1% triamcinolone acetonide along with physiotherapy. Participants were evaluated at baseline and at the 7th day, 14th day, and 21st day. They were evaluated for mouth opening (maximum interincisal distance) and burning sensation (Visual Analogue Scale). Results: The reduction in burning sensation and increase in mouth opening is observed in both the groups. Both groups showed no statistically significant difference. Thus, both are statistically equally effective. Reduction burning sensation at the 21st day was more in Group A than in Group B, but difference is not statistically significant. Conclusion: Novel gel is as effective as topical steroid triamcinolone acetonide in reducing the signs and symptoms of OSMF.

Intravenous immunoglobulins (IVIg) are increasingly being used to treat a wide spectrum of dermatological and neurological autoimmune diseases. Although the administration of IVIg does not usually result in severe adverse reactions, side effects of IVIg reportedly occur in 6-13% of patients. Most reported cases were not severe, and IVIg is considered a relatively safe drug. Some reports described a vesicular eczematous eruption caused by IVIg that was cured by applying topical steroid ointments or systemic steroids. Herein, we present, to the best of our knowledge, the first case of severe vesicular eczematous eruption all over the body induced by IVIg that was unresponsive to topical steroid ointment and was subsequently treated with narrow band-ultraviolet B (NB-UVB) therapy successfully. NB-UVB was started at a dose of 400 mJ/cm2 once a week, and swift improvement was observed. The skin rash disappeared in the first 2 months, and the pathogenesis of IVIg-induced eczematous eruption remains unelucidated. No change in eosinophils and complement levels were observed in our case. Given the increase in the widespread use of IVIg, we have shown that NB-UVB therapy is a candidate choice for the treatment of IVIg-induced severe vesicular eczematous eruption.

Purpose: To describe a case of juvenile idiopathic arthritis (JIA)-associated anterior uveitis after receiving the Sinopharm COVID-19 vaccine.Methods: A retrospective case report.Result: An 18-year-old girl, with a history of antinuclear antibody positive oligoarticular JIA, presented with bilateral anterior uveitis 5 days after the second dose of the Sinopharm COVID-19 vaccine. Ocular examination revealed anterior uveitis with reduced visual acuity in both eyes. Anterior segment optical coherence tomography showed hyperreflective dots in the anterior chamber (AC) and fine endothelial granularities representing the circulating cells in the AC. Uveitis in both eyes resolved gradually after topical steroid treatment without recurrence.Conclusion: This report demonstrates a potential causal association of COVID-19 vaccine with anterior uveitis.

Dermatophytoses, commonly known as ringworm or tinea, represent superficial fungal infections caused by dermatophytes, which are among the most common infections encountered in medicine. Recently, there has been tremendous increase in the incidence of dermatophytosis and also patients don’t respond to the antifungal therapy. Aim - To probe the probable reason for ineffectiveness of subsequent treatment in management of Dadru after pre-use of topical steroid application. Objective - To compare the clinical and mycological cure in participants with or without use of topical steroidal application before participation in clinical trial. Method - An Experimental comparative clinical trial of 6 weeks duration was done in 50 patients with dermatophytic fungal infections, diagnosed clinically with history of using some form of steroidal application. Result - Out of 50 patients 30(60%) patients shown complete cure 20(40%) patients shown ineffectiveness of the treatment, out of 20 patients (75%) patients had history of steroidal use. Conclusion - Misuse of the steroidal formulation in dermatophytic infection may result in ineffectiveness of the treatment.

Purpose: To study the occurrence of pseudo endophthalmitis among patients undergoing intravitreal avastin (Bevacizumab) under various indications. Materials and Methods: A retrospective analysis of case records of patients who developed an inflammatory reaction after Intravitreal avastin (Bevacizumab) was done. Results: Eight of the twenty-Eight patients (28.5%) developed pseudo endophthalmitis. however, the repeated culture of aqueous or vitreous samples did not show any bacterial or fungal growth. all patients showed precipitation of drug in vitreous with the resolution of symptoms after 10 weeks of intensive oral and topical steroid treatment. Conclusion: Intravitreal avastin (Bevacizumab) can result in pseudo endophthalmitis though it is a diagnosis of exclusion. given many complications, a larger clinical trial of intravitreal avastin (Bevacizumab) is needed to rationalize its use. Keywords: Avastin (Bevacizumab), Endophthalmitis, Intravitreal, Pseudo.

Aim: To evaluate the cases of recurrent post operative uveitis after phacoemulsification. Introduction: Post operative uveitis is a common finding after intra-ocular surgery and respond well to corticosteroids. After phacoemulsification the trend is changing and many cases with recurrent inflammation are specific with phacoemulsification which respond well to steroidal therapy and in most cases invasive intervention are not required. In this study we have seen twelve cases of phacoemulsification associated with recurrent attacks of anterior uveitis after completing routine course of medication post operatively. Materials and Methods: This is a retrospective study of 565 cases of uncomplicated cataract (212 SICS + 353 Phacoemulsification) surgery done by a single surgeon in a period of two years between April 2014 to March 2016. All the patients did well during 6 weeks of routine treatment. But 12 patients after completing topical steroid course developed symptoms like decreased vision, photophobia, redness and pain of mild to moderate degree. Slit lamp examination showed mild to moderate circum ciliary congestion with aqueous cell +1 to +3 with some flare and few fine keratic precipitates in some cases. Systemic evaluation was done in all the cases to find out any systemic association with uveitis. Result: All (12 cases) were started with topical corticosteroid 4 times to one hourly depending on grade of uveitis and tapered in next 4-6 weeks. Supportive cycloplegics were given till cells were present in anterior chamber. No oral corticosteroids were given in first attack of uveitis. 6 cases recovered well with this treatment regime. Six cases had recurrent attacks and were given repeat dose of topical steroids and cycloplegic along with oral prednisolone 1mg/kg in weekly tapering doses. 5 cases responded well to single course of oral steroid while one had to give twice full course of oral steroids along with 4 course of topical steroids. Conclusion: V

Purpose To report a case of a culture-negative deep fungal corneal infection that was diagnosed after histopathology of an anterior segment optical coherence tomography-guided endothelial biopsy. Methods A 22-year-old woman with history of contact lens wear and concomitant topical steroid use presented with a mid-stromal corneal infiltrate that failed to respond to oral acyclovir and topical fortified antibiotics. Although cornea stains, cultures, and confocal microscopy showed negative results, there was high clinical suspicion for fungal keratitis. After 2 months on topical natamycin, oral voriconazole, and serial intrastromal and intracameral voriconazole injections, the infiltrate enlarged and deepened. Imaging with anterior segment optical coherence tomography revealed that the infection had progressed to an endothelial plaque. Results Diagnostic endothelial biopsy was performed in the operating room. Cultures showed again negative results, whereas histopathology of the removed specimen revealed fungal elements. The postoperative edema at the site of the biopsy resolved over the course of 4 weeks, and a posterior stromal scar formed. Serial intrastromal and intracameral voriconazole injections were continued for the first postoperative month. At the 1-year and the 3-year follow-up examinations, the patient's vision was 20/20 without recurrence. Conclusions Intraoperative scraping of the endothelial plaque and histopathologic evaluation of the specimen proved to be of utmost importance for definitive diagnosis and resolution of the culture-negative deep fungal infection in this case. This young patient's cornea was retained and vision remains excellent.

Background Ocular graft-versus-host disease (GVHD) is one of the most severe complications of hematopoietic stem cell transplantation. It manifests as an impairment of the ocular surface, such as severe dry eye disease, and deteriorates the recipient's visual function and quality of life. We encountered an "overlap syndrome" of ocular GVHD, which is characterized by the presence of both acute and chronic GVHD symptoms. In this report, we present the treatment progress of the overlap syndrome in a case with ocular GVHD. Case presentation A 57-year-old man with acute myeloblastic leukemia underwent hematopoietic stem cell transplantation. Six weeks after the treatment, the recipient complained of eye pain and discharge. He was diagnosed with the overlap syndrome due to low tear volume, severe corneal epithelitis, hyperemia, and a pseudomembrane on the conjunctiva. Immune cells infiltration, fibrinoid degeneration, fibroblastic and spindle-shaped cells, and fibrosis were observed in the pathology of the pseudomembrane. The recipient was treated with topical immunosuppression and pseudomembrane removal. One week after the initial treatment, ocular GVHD improved. Twelve weeks after the treatment, the topical steroid was discontinued due to the elevation of intraocular pressure. Conclusions The assessment of conjunctival pseudomembrane in ocular GVHD is important to determine the stage of the case and to assess systemic GVHD. Furthermore, prompt removal of the pseudomembrane after diagnosis is an appropriate management to reduce the symptoms of ocular GVHD. The combination of topical steroids and immunosuppressive agents is suggested to be an effective treatment in management of overlap syndrome.

Psoriasis may manifest as severe hyperkeratotic lesions resembling an oyster shell called ostraceous psoriasis (OP). This type of psoriasis is extremely rare and is often associated with psoriatic arthritis (PA). Cases of OP associated with PA in children have never been reported before. We reported a 9-year-old girl with hyperkeratotic lesions resembling an oyster shell all over the body accompanied with swelling on joints of both fingers, knee joints, and ankle. Histopathological examination supported the diagnosis of OP. The diagnosis of PA was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR). Significant improvements of the skin lesions and joints involved were observed within 44 days after the beginning of treatment with cyclosporine and a combination of high potent topical steroid with emollient. OP associated with PA is uncommonly seen in children. High potent corticosteroid combined with emollient showed good result in skin improvement with low side effects. In addition, cyclosporine can be a good choice of systemic therapy for OP with PA in children.

Nocardia species are an uncommon but important cause of keratitis. The purpose of this review is to discus previous published papers relation to the epidemiology, etiology, diagnosis and management of Nocardia keratitis. Nocardia asteroides is the most frequently reported from Nocardia keratitis. Pain, photophobia, blepharospasm and lid swelling are mainly clinical manifestations. Usual risk factors for Nocardia keratitis are trauma, surgery, corticosteroids, and contact lens wear. Several antibiotics were used for treatment of Nocardia infection but according to studies, topical amikacin is the drug of choice for Nocardia keratitis. Topical steroid should not prescribe in these patients. In conclusion, although Nocardia keratitis is rare, early diagnosis and treatment are essential to prevent any scar formation and preserve a good visual acuity.

Background Fear of adverse effects of corticosteroids is common in dermatology and results in medication nonadherence. Objective To study the efficacy of targeted education in reducing topical steroid phobia. Methods In this double-blinded, randomized controlled trial, participants in the intervention arm were presented with an educational video and patient information leaflet targeting common misconceptions of topical corticosteroids. Steroid phobia was assessed with the topical corticosteroid phobia (TOPICOP) scale, medication adherence with the Elaboration d'un outil d'evaluation de l'observance des traitements medicamenteux (ECOB) score, and quality of life with the Dermatology Life Quality Index (DLQI). Results The study randomized 275 patients. The mean TOPICOP score in the intervention arm decreased (improved) from 41.9 (SD, 17.4) to 37.1 (SD, 20.0) and to 33.8 (SD, 19.0) at 1 month and 3 months, respectively, with the reduction arising from the knowledge domain but not the fears and behaviors domain. This remained statistically significant after adjusting for demographic confounding with an expected reduction of 4.22 points (P = .031). After accounting for demographic factors, there was no statistical difference in medication adherence and quality of life. Limitations include the exclusion of non–English-speaking patients. Conclusion Targeted education at a single time point improved the TOPICOP score primarily in the knowledge domain but not in the fear domain.

Background: Aim of this study is to see the efficiency of topical 1% hydrocortisone in the treatment of physiological phimosis. Materials and Methods: Retrospective study was conducted in the Kaski Model Hospital, Pokhara, Gandaki, Nepal from January 2016 to June 2019. Forty-nine patients treated in outpatient basis have been selected for this study. Selection was made according to Kikiros and Woodward retractability grading. Results: Out of 49(100%) patients 40(81.63%) achieved complete response to steroid, which is Kikiros and Woodward retractability grade 0. 2(4.08%) patients showed satisfactory response (symptom free) which is Kikiros and Woodward retractability grade 1. And 7(14.28%) patients showed no response after six weeks course of treatment and underwent circumcision. Conclusion: This study demonstrates the use of 1% topical hydrocortisone is safe, simple and cost effective. And it could be the initial choice of treatment.

To assess the characteristics of glaucoma patients who received systemic or topical steroid treatment. Patients who received steroid treatment were selected from a total of 4256 patients at our tertiary referral center of glaucoma management between August 2011 and October 2017. Clinical characteristics of the subjects were extracted from clinical records. To evaluate the factors influencing highest intraocular pressure during observation (max-IOP) or mean deviations (MDs) of visual field at the first and last visits, univariate and multivariate regression analyses were performed using a generalized estimating equation. Three hundred and eighty-two eyes of 196 patients were included in this study. The most frequent disease as the reason for steroid treatment was atopic dermatitis (58 eyes) followed by autoimmune diseases. The patients with atopic dermatitis were significantly younger (38.0 ± 11.2 years old, p < 0.001) and had lower MD (− 9.3 ± 9.1 dB at first visit, p = 0.01; − 10.6 ± 9.2 dB at last visit, p = 0.004) than those with other diseases. In multivariate regression analysis, age and MD at first visit, max-IOP, and atopic dermatitis were correlated with MD at last visit. The results of the present study suggest that patients with atopic dermatitis carry the risk of irreversible visual field loss even in youth. For earlier detection of high intraocular pressure, reinforcement of ophthalmological screening in management of atopic dermatitis should be recommended.

PURPOSE The aim of this study was to report topical steroid usage in bacterial keratitis and analyze the effects of steroids on patients' outcomes to the main causative organisms. DESIGN A retrospective case-series. METHODS This study included all patients with corneal scrape positive bacterial keratitis from January 2012 to December 2016 at the Sydney Eye Hospital, Sydney, Australia. Cases were identified from pathology results and hospital coding, and data collected from medical records. RESULTS A total of 313 eyes from 308 patients with a mean age of 51 years [interquartile range (IQR) 36-72] were included. Of these patients, 192 (61%) were treated with topical steroids. High-dose steroids were prescribed in 22 (11%) cases, regular-dose in 88 (46%), and low-dose in 82 (43%). The median time until the implementation of steroid use was 4 days (IQR 3-7). Patients prescribed with topical steroids had significantly longer healing times than the "no steroid" group (11 vs 6.5, P

Purpose: presentation of a clinical case of an idiopathic macular hole (IMH) recurrence after its successful closure augmented with platelet-rich plasma (PRP) and the results of repeated surgical treatment.Methods. The patient underwent clinical examination and optical coherence tomography (OCT) of the retina before and after surgical treatment. А 2-stage surgical treatment of the left eye with an interval of 7 days: phacoemulsification (PE) followed by microinvasive vitrectomy with Internal limiting membrane peeling (ILM) and closure with the use of PRP. The patient was discharged with improved visual acuity and closure of the macular hole (MH). After 2 weeks vision deterioration was noted by the patient in the operated eye. Clinical examination revealed macular edema (ME) and recurrence of MH. Topical steroid eye drops were used to no avail, with increase of ME and MH via OCT control. Revision of the vitreal cavity augmented with PRP was performed.Results. In follow-up a complete closure of the MH, resolution of ME and improvement in visual acuity after repeated surgery was confirmed.Conclusions. A case of recurrent MH after primary closure with PRP is described. The case suggests a possibility of clinical improvement after repeated MH closure augmented with PRP. The causes and mechanisms of the recurrence of MH are still not clear. Despite the positive results of surgery subsequent OCT retina examination is necessary.

In this review, we overview the incidence and management of cystoid macular edema following endothelial keratoplasty (EK) including Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Incidence of CME was 2.0–12.7% following DSAEK and 0.7–15.6% following DMEK. Glaucomatous eyes, in particular, with primary angle closure glaucoma and eyes with severe iris damage and eyes with combined EK with transscleral intraocular lens implantation experienced postoperative CME at a higher incidence. Topical non-steroidal anti-inflammatory (NSAIDs) and intensive topical steroid can effectively treat and prevent CME recurrences. CME is one of the major complications following EK and can be involved in the limitation of the recovery of postoperative visual acuity. Careful attention should be paid to patients with systemic and ocular conditions, as these might trigger postoperative CME. The prophylactic use of NSAIDs and intensive steroid treatment may be a reasonable approach.

Objectives The aim of this study was to investigate the distribution of microbial agents in the early and late postoperative periods in patients with microbial keratitis (MK) after penetrating keratoplasty (PK). Materials and methods The records of 36 patients who were clinically diagnosed as having MK after PK were retrospectively reviewed. Culture results were obtained from microbiology records and the organisms that were produced were noted. A case was deemed as viral keratitis based on the clinical appearance, negative cultures, and response to antiviral treatment. Keratitis development times were evaluated in 2 categories: early (within the first year) and late (after year 1) postoperative period. Mann-Whitney U and Kruskal-Wallis tests were used to compare numerical variables that did not show normal distribution and chi-square test was used to compare categorical variables. Results The majority of MK cases were of bacterial origin (55.5%, n=20), followed by viral (41.7%, n=15) and fungal (2.8%, n=1). Of the 15 cases of early postoperative MK, 10 were bacterial, 4 were viral, and 1 was fungal; however, among cases of late postoperative MK, 10 were bacterial and 11 were viral. The majority (65%) of early and late bacterial infections were caused by gram-positive strains (most commonly staphylococci). Gram-positive bacteria caused keratitis significantly earlier than gram-negative bacteria (p=0.037). Viral and gram-negative bacterial MK was more frequent in the late postoperative period, but the difference was not statistically significant. Conclusion In our study, bacterial keratitis was more common in post-keratoplasty MK than viral and fungal keratitis. Gram-positive bacteria were the most common causative agents. The increased incidence of gram-negative bacterial agents and viral keratitis in the late postoperative period can be explained by long-term topical steroid use.

Purpose Investigation of the efficacy and safety of 12 months of topical tacrolimus 0.03% ointment treatment against the subepithelial infiltrates (SEIs) due to adenoviral keratoconjunctivitis (AKC) resisting at least 2 years was aimed. Methods This case series included consecutive patients with SEIs secondary to AKC who were resistant to topical steroid and ciclosporin-A (CSA) treatment and treated with topical 0.03% tacrolimus (Protopic; Fujisawa Healthcare, Teva, Deerfield, Illinois, USA) for 12 months, at least 2 years after AKC. For the evaluation of treatment efficacy, best-corrected visual acuity (BCVA), Fantes score, corneal subepithelial infiltrate score (CSIS), Oxford score, Schirmer and tear breakup time results were evaluated. Intraocular pressure and complaints of the patients were followed for evaluating the safety profile of the treatment. The patients were followed after the baseline visit at the 1st, 3rd, 6th and 12th month. Results 15 eyes of 11 patients with SEIs and 16 eyes of 16 healthy controls were included in this study. 1 patient (9.1%) could not tolerate the treatment. Significant improvements in BCVA, CSIS, Fantes score and Schirmer results were observed in the study group starting from the 3rd-month visit, and the improvements persisted until the end of 12 months of treatment. Conclusion Topical 0.03% tacrolimus might show efficacy against the SEIs persisting at least 2 years despite corticosteroid and/or CSA treatment without any prominent side effect. While at least a period of 3 months was necessary for a significant improvement in the BCVA, SEIs and Schirmer results, a period of 6 months was necessary for a decrease in Oxford score.

To address concerns related to the safety profile of both Food and Drug Administration (FDA)-approved and non-FDA-approved intranasal corticosteroid (INCS) use in the adult population.Systematic review of MEDLINE, PubMed, and EMBASE databases using a comprehensive search strategy including all INCS formulations and adverse events. The study design was developed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional sources were identified from study references of relevant articles.A structured literature search was conducted. Each study was graded for level of evidence using the Oxford Centre for Evidence-Based Medicine. Extracted data included population size, study design, drug (dosage, route, and frequency), presence of hypothalamus pituitary axis suppression, ocular symptoms, and treatment-related adverse events.A total of 60 studies met inclusion criteria. The studies included use of INCS as metered nasal sprays, drops, injections, aerosols, and irrigations. There were no persistent abnormalities in cortisol level or intraocular pressure change. Meta-analysis of epistaxis showed a significantly increased risk in the FDA-approved treatment group in comparison with control (risk ratio 1.56; 95% confidence interval, 1.13-2.14;Overall, it appears that the use of both FDA and published non-FDA application of INCS are safe in the adult population. Meta-analysis demonstrated an increased risk of epistaxis in patients using INCS compared with placebo. Otherwise, there was no significant difference between in adults in the treatment group and placebo group. As an important caveat, the interpretation of safety of nonstandard INCS is restricted to delivery methods and dosages published in the literature.