Objective To evaluate the efficacy and safety of intravitreal triamcinolone acetonide combined of macular laser grid photocoagulation (IVTA/MLG) versus macular laser grid (MLG) photocoagulation only for treatment of diabetic macular edema. Methods A computerized search was conducted in the Cochrane Library, Embase Library, Pubmed, Chinese Biomedical Database, Chinese Journal Full-text Database and Chinese Science and Technology Periodicals Database. Randomized controlled trials (RCT) on IVTA/MLG and MLG only for treatment of diabetic macular edema were selected. After the data extraction, quality of RCT was assessed. The meta analysis was performed by RevMan 5.1.The outcome measures included best-corrected visual acuity (BCVA) and the central foveal thickness (CMT). Results In total, six RCT that fulfilled the eligibility criteria were included in the metaanalysis involving 166 eyes in MLG group and 165 eyes in IVTA/MLG group. The results suggested that there was no significant differences in BCVA (Z=1.27,P=0.20), but differences were statistically significant comparing CMT (Z=2.41,P=0.02), incidence of ocular hypertension and cataract (Z=3.62,P＜0.01) between MLG and IVTA/MLG groups at the six month follow-up. Conclusions There is no significant advantage of IVTA/MLG as compared with MLG,but it could reduce CMT. However, a high-quality, large sample RCT should be further investigated.
Objective To evaluate the effects of retinal cryotherapy and intravitreal triamcinolone injection to treat Coatsprime; disease with exudative retinal detachment.Methods This was a prospective consecutive case study, and 21 patients (21 eyes) with Coatsprime; disease accompanied by exudative retinal detachment were enrolled. There were 19 males and two females patients, aged from two to 18 years. Fifteen eyes had partial retinal detachment (stage 3A) and six eyes had total retinal detachment (stage 3B). All patients underwent cryocoagulation and intravitreal triamcinolone injection. Three eyes underwent sclerotomy to drain subretinal fluid. Four eyes underwent further treatment by photocoagulation or cryotherapy for the residual abnormal blood vessels after the surgery. The follow-up ranged from three to 15 months with an average of seven months. Visual acuity, intraocular pressure, eye position and eye movements, slit lamp microscope, indirect ophthalmoscope and color fundus imaging were followed up. The last followup time was considered as the judgment time for the therapeutic effects. Results Six eyes had increased intraocular pressure after the surgery, which was controlled by local drug treatment. At the end of follow-up, 19 eyes had reattached retina, one eye had partial retinal detachment and one eye had total retinal detachment. The vision improved in three eyes,unchanged in 14 eyes, and decreased in two eyes. Other complications included strabismus (one eye) and cataract (four eyes). Conclusion The combined treatment of cryotherapy and intravitreal triamcinolone injection is an effective therapy for the Coatsprime; disease with exudative retinal detachment, as retina reattaches and visual function is saved in most patients after this treatment.
Objective To observe the influence of triamcinolone acetonide (TA) on the expression of pigment epitheliumderived factor (PEDF) of human retinal pigment epithelial (RPE) cells. Methods Cultured humanRPE cells (4th－6th generations) were treated with four different concentrations of TA (40, 400, 4times;103 and 4times;104 mu;g/L) for three different periods (12 or 24 or 48 hours), the levels of PEDF protein in the cell culture supernatant and cell lysates were determined by Western blot. After the initial experiment, RPE cells were treated with or without tumor necrosis factor-alpha; (TNF-alpha;, 20 ng/ml） for 24 hours, followed by TA (400 mu;g/L) treatment. The levels of PEDF and phospho-p38 mitogen activated protein kinase(p-p38MAPK) protein expression in cell culture supernatant and cell lysates were measured by Western blot. Results TAtreated RPE cells had higher PEDF expression, and 400 mu;g/L TA group had the highest effect (F＝16.98,P＜0.05). 400 mu;g/L TA treatment for one, six or 24 hours, with or without TNF-alpha; pretreatment, could all promote the PEDF expression and inhibit the p-p38MAPK protein expression (F＝16.87, 10.28; P＜0.01). TNF-alpha; pretreatment alone could inhibit PEDF protein expression and promote p-p38MAPK protein expression (F=16.87, 10.28; P＜0.01). Conclusions TA can up-regulate the expression of PEDF, and downregulate the expression of p-p38MAPK in the cultured human RPE cells.
Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation（MLGP）to treat macular edema.Methods Consecutive 89 patients （109 eyes）diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving-0.8 (0.19plusmn;0.13)；the intraocular pressure（IOP）ranged from 7 mm Hg to 21 mm Hg（1 mm Hg=0.133 kPa）and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations，the central macular thickness was （570plusmn;182）mu;m；the average light sensitivity was （5.07plusmn;3.94） dB and the fixation percentage was 70.67% within 4 deg;area around the macular fovea. All the patients received IVTA treatment，39 patients（48 eyes）further received MLGP 1 month later (IVTAMLGP group). The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group. Best corrected visual acuity (BCVA),IOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months，the BCVA in IVTAMLGP and IVTA group was （0.41plusmn;0.20）、（0.24plusmn;0.19）respectively (P＜0.05)；the central macular thickness was （309plusmn;187） and （487plusmn;206） mu;m respectively（P＜0.05）；the mean light sensitivity of 4deg; central macular was （8.24plusmn;4.64）and（6.30plusmn;3.22）dB respectively（P＜0.05）；the fixation percentage was（87.01plusmn;19.70）% and（78.85plusmn;20.41）% respectively （P＜0.05）. During the followup recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTAMLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema.
Objective To observe the changes of intraocular pressure (IOP) after intravitreous injection wih triamcinolone acetonide (TA) and their affected factors. Methods The clinical data of 125 patients (125eyes) who had undergone intravitreous injection with TA were retrospectively analyzed. The patients (52 males and 73 females) aged from 17 to 83 years with the average age of 56.5. There were 49 patient (39.2%) with diabetic retinopathy (DR), 56 (44.8%) with retinal vein occlusion (RVO), and 20 (16.0%) with exudative age-related macular degeneration (AMD). One day before the treatment, IOP was measured by Goldmann applanation tonometry, and the basic IOP was 7~31 mm Hg (1 mm Hg=0.133 kPa) and the average IOP was (14.69plusmn;3.72) mm Hg. The patients were divided into two groups according to the basic IOP:below 15 mm Hg group (n=64) and 15 mm Hg or above group (n=61). All of the patients underwent intravitreous injection with 4mg TA. IOP was measured 1 day, 3 days, 1 week, 2 weeks, and 1 month after the treatment in the same way, respectively, and later was measured once every 1 month. The follow-up period was 3~21 months with the mean of 5 months. The elevation of IOP would be defined as the pressure of 21mmHg or higher. The changes of IOP in patients before and after the treatment, and with different diseases and ages were analyzed. Results Thirty-six patients (28.8%) had elevation of IOP after the treatment, out of whom 97.2% had the elevation within 3 months after the injection and decreased to the basic level 7 months after the injection. In these patients, there were 11 (17.19%) in the below 15 mm Hg group and 25 (40.98%) in 15 mm Hg or above group, and the difference between the two groups was statistically significant (P＜0.01）. During the followup period, the mean maximum IOP was (20.09plusmn;7.58) mmHg, which was 5.43 mmHg higher than that before the treatment（P＜0.001）. The mean maximum IOP of 53 patients (42.4%) after the treatment was 5 mm Hg higher than that before the treatment. The mean maximum IOP during the followup period was （18.19plusmn;4.73）mmHg in DR group，（22.50plusmn;9.30）mmHg in RVO group, and（18.12plusmn;6.09）mmHg in AMD group. The occurrence of the elevation of IOP in RVO group was obviously higher than that in the other 2 groups (P＜0.01）. The result of regression analysis showed that age was correlative with the elevation of IOP after the treatment: more risks of occurrence of high IOP were found in younger patients (P=0.000). Conclusion Elevation of IOP after intravitreous injection with TA is common, which is correlative with the basic IOP, age, and pathogeny. After the intravitreous injection with TA, the elevation of IOP often occurs in patients with high basic IOP before treatment, younger age, and RVO. (Chin J Ocul Fundus Dis, 2007, 23: 115-117)
Objective To investigate the relationship between expression of retinal intercellular adhesion molecule-1 (ICAM-1) and blood-retinal barrier (BRB) rupture and therapeutic effect of intravitreous injection with triamcinolone acetonide (TA) on blood-retinal barrier rupture in rats with diabetes mellitus (DM). Methods Diabetic model of Wistar rats was induced and were divided into normal control group, DM-4-month group and DM-6-month group. Each group was subdivided into immunohistochemcial staining and BRB measurement groups. BRB measurement group was further divided into non-TA treatment group, 1-week-TA treatment group, and 2-week-TA treatment group. The rats were intravitreously injected with 5 mu;l TA. The digested retinal preparation was stained by immunohistochemcial method to observe the expression of retinal ICAM-1 and morphological changes. The mean optic density (A) value of endothelial cells was measured by image-analyzing software to quantify the expression of ICAM-1. BRB changes were measured by content test of retinal Evans blue (EB). Results In the immunohistochemcial staining groups, there was no significant positive expression of ICAM-1 in retinal capillary in control group. Compared with the control, there was significant positive expression of ICAM-1 in DM-4-month group (P＜0.001) with some morphological changes such as irregular width of capillary caliber, and there was enhanced positive expression of ICAM-1 in DM-6-month group (P＜0.001) with aggravated morphological changes and even acellular capillary. In the BRB measurement groups, there was no significant difference of EB content(P＞0.05) among control groups. The EB content in two DM groups significantly increased compared with that in the controls (Plt;0.001), and higher in DM-6-month group than that in DM-4-month group (Plt;0.01). In TA treatment groups, the EB content in all the DM groups significantly decreased (Plt;0.001) but with no significant difference among the groups(P＞0.05). EB content in DM-4-month group after 2-week treatment almost reached to normal value (P＞0.05) while was higher in the rest of TA treatment groups than that in the control group (Plt;0.05). Rectilinear correlation between A value of endothelial cells and the retinal EB content(r=－0.959)was found. Conclusion There is a positive relation between the expression of ICAM-1 and BRB rupture in retina of DM rats, and intravitreous injection with TA can effectively alleviate BRB rupture. (Chin J Ocul Fundus Dis, 2006, 22: 24-27)
ObjectiveTo observe the effect of triamcinolone acetonide(TA) on activation and barrier function of human retinal pigment epithelium （RPE）.MethodsARPE-19 cells were cultured in 96well tissue culture plate. Four weeks later, TA with different concentration (0.02 and 0.05 mg/ml)was added to the cells and culture for 3 or 7 days. The activation of ARPE-19 cells was assessed by methyl thiazolyl tetrazolium (MTT). ARPE-19 cells were cultured on polyester microporous filters for 4 weeks, and the transepithelial resistance (TER) was recorded. TA (0.02 and 0.05 mg/ml) was added to the culture fluid respectively, and after cultured for 1 week TER was measured again. The RPE permeability was detected by enzymelinked immunosorbent assay (ELISA) with horse radish peroxidase as the tracer. ResultsIn the culture fluid with 002 mg/ml TA cultured for 3 or 7 days, the average survival rate of ARPE-19 cells was 93.70% and 90.63% respectively, without statistic difference compared with the control (P=0.147, 0.091). While in the 0.05 mg/ml TA group after cultured for the same duration, the activation of ARPE-19 cells decreased significantly compared with the control (with the average survival rate of 87.75% and 88.98%; P=0.025, 0.043). One week after cultured with TA, TER decreased significantly while permeability improved obviously in the 2 TA groups compared to the control (Plt;0.001; 0.001lt;Plt;0.05).ConclusionTA may decrease the activation of and destroy the barrier function of ARPE-19 cells. (Chin J Ocul Fundus Dis, 2005,21:237-239)
ObjectiveTo investigate the cytotoxicity of triamcinolone acetonide (TA) on cultured human retinal pigment epithelial (RPE) cells.MethodsEffect of TA with different concentraion (0.4, 02, 01, 0.05, and 0.025 mg/ml) on the proliferation of RPE cells was detected by methyl thiazolyl tetrazolial (MTT) assay; The changes of cellular cycle treated by TA with the drug concentration of IC50 for 72 hours were measured by flow cytometry (FCM) ananlysis, and the morphological and ultrastructural changes of the cells were observed by phasecontrast microscopy and transmission electron microscopy.ResultsWith the concentration of 0.4-0.025 mg/ml, TA inhibited the growth of RPE cells obviously in a dose-dependent manner compared with the control (P＜0.05), and the cells in S phase treated with TA decreased 10.6% compared with the control (P＜0.05). Under the light microscope, sparse cells with irregular configuration and many prominences and cellular vacuoles in TA group can be seen. The results of transmission electron microscopy showed asymmetrically distributed cellular chromatin was, cavitated cytoplasm, and even some necrotic cells.ConclusionTA can inhibite the S-phase karyomitosis of RPE and inhibite the cellular proliferation; and destroye the cellular structure and lead to the necrosis, which indicates the cytotoxicity of TA on RPE.(Chin J Ocul Fundus Dis, 2005,21:233-236)
ObjectiveTo discuss the role and effect of the triamcinolone acetonide (TA) injection applied in the vitreoretinal surgery for assisting to distinguish and removal residual cortex.MethodsOne thousand and forty-six patients (1 056 eyes) underwent a PPV at West China Eye Center from August 2003 to February 2005. These affected eyes were selected without posterior vitreous detachment pre-and intra-operatively, and underwent intravitreal injection with TA 1-2 mg to label the residual vitreous cortex on the surface of the posterior retina after removal of the majority vitreous.ResultsThe location and coverage of the residual vitreous cortex were clearly be shown by the white appearance of TA labeled residual vitreous, and the residual vitreous cortex was conveniently to be recognized and removed.ConclusionThe application of intravitreal injection with TA is helpful for identification and elimination of the residual vitreous cortex in vitreoretinal surgery.(Chin J Ocul Fundus Dis, 2005,21:226-228)
ObjectiveTo evaluate the efficacy and security of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsA total of 41 eyes in 37 patients with macular edema who measured up were collected, including 21 eyes of 21 cases in retinal vein occlusion (RVO) group, 17 eyes of 13 cases in diabetic retinopathy (DR) group, and 3 eyes of 3 cases in the other-causes group. Before the treatment, the average visual acuity was 0.07, 0.06, and 0.08 in the 3 groups respectively, and the mean thickness of macular fovea detected by optic coherence tomography (OCT) was (974±394) and (873±213) in RVO and DR group, respectively. Intravitreous injection with 0.1 ml TA (40 mg/ml) was performed on each patient. The average follow-up duration was 8 months after the treatment. The visual acuity, intraocular pressure (IOP), changes of lens and ocular fundus, and retinal thichness at macular area before and after the treatment was observed and compared.ResultsAll eyes except one had improved visual acuity. The mean visual acuity improved to 0.25, 0.20, and 0.35 in the 3 groups respectively 6 months after the treatment. Alleviated or reducing macular edema was found in all of the patients. The average retinal thickness at macular fovea was (173±41) and (204±76) in RVO and DR group respectively 1 month after the treatment, which had statistical significance compared with that before the treatment (t =8.323, 6.842; P＜0.01). The intraocular pressure was ＞21 mm Hg (1 mm Hg = 0.133 kPa) in 6 eyes (14.6%), which mostly happened 1 week to 2 months after the injection, and was controlled to normal level after partially treated with βreceptor retarder. The cataract developed in 1 eye, and another patient with macular edema after vitrectomy due to diabetes had macular hole 2 months after the injection. There were 2 eyes underwent intravitreous injection with 0.1 ml TA 4-5 months after the first treatment due to the recurrence of macular edema in RVO and DR group respectively.ConclusionsIntravitreous injection with TA is a promising therapeutic method for macular edema that fails to respond to conventional treatment. Transient elevation of ocular pressure is the most common side effect. Further study is needed to assess the long-term efficacy and safety. (Chin J Ocul Fundus Dis, 2005,21:209-212)