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Background Alopecia areata (patchy alopecia) is an inflammatory disease which leads to hair loss over scalp and body. It is prevalent in 0.2% of the population without any racial or sexual predilection and may affect any age group and is prevalent in 25% of almost all alopecia cases.1 Azathioprine exerts its full effect after 4 to 6 weeks due to which most of our patients would leave treatment in initial phase of treatment. To cover up this issue of compliance and to increase its efficacy, we bridged this gap of 4 to 6 weeks with single shot of triamcinolone acetonide intramuscular injection. Although corticosteroids are effective in the treatment of alopecia areata whether administered intramuscularly, orally or intralesionally but since it is a chronic disorder and its long term use can lead to potential irreversible adverse effects, the need for steroid sparing immunosuppressive agents like azathioprine is recommended, which has favorable therapeutic action without many systemic side effects (success rate of 28.5 to 61%). Objective To investigate the efficacy of azathioprine with triamcinolone acetonide as a bridging therapy for the management of alopecia areata and its spectrum. Methods Two hundred patients with alopecia areata participated in an interventional single-arm pre and post-study at the Fauji Foundation Hospital in Rawalpindi from August 2018 to January 2021. After receiving consent, patients from dermatology OPD and inpatient settings were recruited. Patients were chosen using a non-probability consecutive sampling procedure. Results Calculation of the SALT score was done using the given formula as pretreatment and 8 weeks post treatment score. There is a 40.3% decrease in SALT score 12 weeks after treatment; the mean pre-treatment score was 35.65±3.7SD. 8 weeks after treatment, SALT score was 20.65±3.7SD and the difference between mean SALT score before and after treatment is statistically significant (t=34.3, p=<0.05). [ABSTRACT FROM AUTHOR]

Objectives: To see the effect of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection in refractory Diabetic Macular Edema (DME). Study Design: Quasi-Experimental Study. Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi, from Jun to Dec 2018. Methodology: Patients with Clinically Significant Macular Edema (CSME), with Central Macular Thickness (CMT) >300 microns and those who did not respond to three consecutive Intra-Vitreal Bevacizumab (IVB) injections were included. Posterior Subtenon Triamcinolone Acetonide (PSTT) was administered by a single retina fellow using the same protocol. Each patient's best-corrected visual acuity (BCVA), Intra-ocular pressure (IOP) and Central Macular Thickness (CMT) were evaluated on the day of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection and again at 1, 3 and 6 months. Results: Out of 52 patients (104 eyes), 16 females and 36 males were present. The mean age was 57.67±9.35 years. Out of 52 right eyes, the mean Central Macular Thickness (CMT) at the first visit was 388.83±172.04 pm, 332.81 ± 144.69 pm after one month, 292.81±147.59pm after six months of Posterior Subtenon Triamcinolone Acetonide (PSTT) Injection. Similarly, for 52 left eyes mean Central Macular Thickness (CMT) at the first visit is 375.79±160.81 pm, 364.52 ± 167.95 pm after one month and 323.37±155.74 pm after six months. Similar results were observed for IOP and BCVA. Conclusion: Posterior Subtenon Triamcinolone (PSTT) injections are effective in diabetic macular oedema, which does not respond to intravitreal anti-VEGF (IVB) therapy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of intravitreal triamcinolone for refractory diabetic maculopathy after 03 unsuccessful intravitreal bevacizumab injections. Study Design: Prospective observational study. Place and Duration of Study: Retina department of Al-Shifa Trust Eye Hospital Rawalpindi, from Jun 2016 to Jul 2017. Methodology: Total 35 eyes of 35 patients who were diagnosed with diabetic maculopathy and having history of minimum three intravitreal Bevacizumab injections were included. Detailed eye examinations included visual acuity, anterior and posterior segment examination and intraocular pressure measurement was performed in all patients. Central macular thickness was also measured. Then intravitreal triamcinolone was administered to eyes by principal researcher (Ophthalmologist). After one month, follow up examination of patient’s eyes was done to assess the effects of injection. Results: Majority of the participants were males 19 (55%) in this research. There was statistically significant difference between means of intra ocular pressure (mean difference= 4.30 ± 5.41), Visual acuity (mean difference=2.8 ± 2.4) and central macular thickness (mean difference = 236.4 ± 13) pre and post injection was found (p-value<0.05). Conclusion: There was statistically significant difference of central macular thickness and visual acuity, pre and post intravitreal triamcinolone acetonide injection was found. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of Intravitreal Bevacizumab in combination with Posterior Subtenon Triamcinolone for treatment of different levels of diabetic macular edema. Study Design: Comparative cross sectional study. Place and Duration of Study: This study was done in Retina Clinic, Al Shifa Trust Eye Hospital, Rawalpindi, from Jul 2017 to Dec 2017. Methodology: Total of fifty-two patients were included in the study which were divided into two groups on the basis of foveal thickness (group 1 = Foveal Thickness <500μm, group 2 = Foveal Thickness >500μm). Results: Both groups were treated with combination of Intra-vitreal Avastin and Posterior Subtenon Triamcinolone. The percentage decrease in foveal thickness after 6 weeks of injection in group 1 was 30.08 ± 13.035% as compared to 38.88 ± 8.883% in group 2 (p=0.006). While the improvement in BCVA in both groups after 6 weeks of injection was same (0.2 ± 0.2 in Log MAR) (p=0.521). Conclusion: It is concluded that the use of Intravitreal Bevacizumab in combination with posterior subtenon triamcinolone for treatment of macular edema is more effective in foveal thickness >500μm as compared to thickness <500μm. [ABSTRACT FROM AUTHOR]

Objectives: To see the effect of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection in refractory Diabetic Macular Edema (DME). Study Design: Quasi-Experimental Study. Place and Duration of Study: Retina Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi, from Jun to Dec 2018. Methodology: Patients with Clinically Significant Macular Edema (CSME), with Central Macular Thickness (CMT) >300 microns and those who did not respond to three consecutive Intra-Vitreal Bevacizumab (IVB) injections were included. Posterior Subtenon Triamcinolone Acetonide (PSTT) was administered by a single retina fellow using the same protocol. Each patient's best-corrected visual acuity (BCVA), Intra-ocular pressure (IOP) and Central Macular Thickness (CMT) were evaluated on the day of Posterior Subtenon Triamcinolone Acetonide (PSTT) injection and again at 1, 3 and 6 months. Results: Out of 52 patients (104 eyes), 16 females and 36 males were present. The mean age was 57.67±9.35 years. Out of 52 right eyes, the mean Central Macular Thickness (CMT) at the first visit was 388.83±172.04 µm, 332.81 ± 144.69 µm after one month, 292.81±147.59µm after six months of Posterior Subtenon Triamcinolone Acetonide (PSTT) Injection. Similarly, for 52 left eyes mean Central Macular Thickness (CMT) at the first visit is 375.79±160.81 µm, 364.52 ± 167.95 µm after one month and 323.37±155.74 µm after six months. Similar results were observed for IOP and BCVA. Conclusion: Posterior Subtenon Triamcinolone (PSTT) injections are effective in diabetic macular oedema, which does not respond to intravitreal anti-VEGF (IVB) therapy. [ABSTRACT FROM AUTHOR]