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

  • Neurophthalmology
  • Published:
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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.

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Authors and Affiliations

  1. Ophthalmology Unit, S.Orsola-Malpighi Teaching Hospital, DIMES, University of Bologna, Via Pelagio Palagi 9, 40138, Bologna, Italy

    Giuseppe Giannaccare, Laura Primavera, Chiara Maiolo, Michela Fresina & Emilio C. Campos

Authors
  1. Giuseppe Giannaccare
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  2. Laura Primavera
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  3. Chiara Maiolo
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  4. Michela Fresina
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  5. Emilio C. Campos
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Corresponding author

Correspondence to Giuseppe Giannaccare.

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No funding was received for this research.

Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

Informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Giannaccare, G., Primavera, L., Maiolo, C. et al. Steroid intra-trochlear injection for the treatment of acquired Brown syndrome secondary to trochleitis. Graefes Arch Clin Exp Ophthalmol 255, 2045–2050 (2017). https://doi.org/10.1007/s00417-017-3757-z

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  • DOI: https://doi.org/10.1007/s00417-017-3757-z

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