Effect of aflibercept combined with triamcinolone acetonide on aqueous humor growth factor and inflammatory mediators in diabetic macular edema

AIM:To investigate the efficacy of aflibercept combined with sub-tenon injection of triamcinolone acetonide(TA)in treating diabetic macular edema(DME)and to examine changes in growth factors and inflammatory mediator levels in aqueous humor after injection.METHODS:Totally 67 DME patients(67 eyes)and 30 cataract patients(32 eyes)were enrolled as the DME group and the control group,respectively.The DME group was divided into the aflibercept group(34 cases)and the aflibercept combined with TA group(combined group,33 cases).The aqueous humor of both groups was collected during the study period.The aqueous levels of vascular endothelial growth factor(VEGF),monocyte chemoattractant protein-1(MCP-1),interleukin-6(IL-6),interleukin-8(IL-8),and interleukin-1β(IL-1β)were detected using a microsphere suspension array technology(Luminex 200TM).Aqueous cytokines,best-corrected visual acuity(BCVA),central macular thickness(CMT),and complications before and after treatment were compared between the aflibercept group and combined group.RESULTS:The concentrations of VEGF,MCP-1,IL-6,and IL-8 in the aqueous humor were significantly higher in the DME group than those of the control group(all P<0.01).After 1mo of surgery,the concentrations of VEGF,MCP-1,IL-6,and IL-8 in the aqueous humor were significantly lower in the combined group than those of the aflibercept group(all P<0.01).The BCVA and CMT values of the two groups were statistically different after 1 and 2mo of treatment(P<0.01).However,the difference was not statistically significant after 3mo of treatment(P>0.05).CONCLUSION:The cytokines VEGF,MCP-1,IL-6,and IL-8 in the aqueous humor of DME patients are significantly increased.Aflibercept and aflibercept combined with TA have good efficacy in DME patients,can effectively reduce CMT,improve the patient’s vision,and have high safety.Aflibercept combined with TA can quickly downregulate the aqueous humor cytokines and help to relieve macular edema rapidly.However,the long-term efficacy is comparable to that of aflibercept alone.

Posterior sub-Tenon triamcinolone acetonide injection for annular choroidal detachment resistant to systemic immunosuppressive treatment

Dear Editor,I report two cases of annular choroidal detachment,which was resistant to systemic immunosuppressive treatment and presented a diagnostic dilemma but responded to posterior sub-Tenon triamcinolone acetonide(PSTA)injections.Annular choroidal detachment is known to occur in uveal effusion syndrome(UES)[1].

Lasiodonin Acetonide的NMR数据解析

对lasiodoninacetonide进行了1H和13CNMR检测,参考lasiodonin,maoecrystalT,wikstroemioidinB和rabdocoetsinA的1H、13CNMR数据,通过DEPT和1H-1HCOSY、HSQC、HMBC等2DNMR技术对该化合物所有的1H和13CNMR信号进行了全归属和详细解析.

Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion

AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS: In group 1, the mean BCVA improved from 37.78 +/- 6.14 (baseline) to 48.06 +/- 3.86, 46.48 +/- 4.77 and 44.18 +/- 5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92 +/- 6.20 (baseline) to 50.69 +/- 4.22, 48.76 +/- 5.59 and 45.70 +/- 6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.

Comparison of intravitreal bevacizumab with intravitreal triamcinolone acetonide for treatment of cystoid macular edema secondary to retinal vein occlusion : a Meta-analysis

AIMTo compare the effects of intravitreal injection of bevacizumab (IVB) with intravitreal triamcinolone acetonide (IVTA) on the treatment of cystoid macular edema (CME) secondary to retinal vein occlusion (RVO).METHODSA literature search was conducted using PubMed, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. The comparison was divided into two groups, group 1 conducted comparison in branch RVO (BRVO) or central RVO (CRVO), group 2 conducted comparison in ischemic-RVO or nonischemic-RVO. Pooled mean differences (MDs) for changes in visual acuity (VA), central macular thickness (CMT) and intraocular pressure (IOP) were calculated in groups at 4, 12 and 24wk after treatment respectively.RESULTSEight studies comparing the efficacy of IVB with IVTA were included in the Meta-analysis. In group 1, in BRVO, significant difference was shown on the comparison of CMT at 24wk (MD, -45.66; 95% CI, -76.03 to -15.28; P=0.003), IVB was effective on BRVO for at least 24wk; no significant differences were found in the comparison of VA at each time points (P&#x0003e;0.05 respectively). In CRVO, no significant differences were found in the comparison of VA or CMT between IVB and IVTA at each time points (P&#x0003e;0.05, respectively). In group 2, in ischemic-RVO, significant differences were shown in the comparison of VA (MD, -0.28; 95% CI, -0.42 to -0.14; P&#x0003c;0.0001) and CMT (MD, -86.50; 95% CI, -151.18 to -22.43; P=0.008) at 24wk; In nonischemic-RVO, no significant differences were demonstrated in the comparison of VA or CMT between IVB and IVTA at each time points (P&#x0003e;0.05, respectively). The occurrence of high IOP was much lower in IVB group.CONCLUSIONThis Meta-analysis suggested that IVB was effective in decreasing CMT in BRVO for at least 24wk, IVB is more effective on improving VA and reducing CMT in ischemic-RVO. IVB is more promising on RVO than IVTA.

Comparison of intravitreal bevacizumab and triamcinolone acetonide theraphies for diffuse diabetic macular edema

AIM: To compare therapeutic effects of intravitreal triamcinolone acetonide(IVTA) versus intravitreal bevacizumab(IVB) injections for bilateral diffuse diabetic macular edema(DDME). METHODS: Forty eyes of 20 patients with bilateral DDME participated in this study. For each patient, 4 mg/0.1 m L IVTA was injected to one eye and 2.5 mg/0.1 m L IVB was injected to the other eye. The effects of injection for diabetic macular edema(DME) were evaluated using best-corrected visual acuity(BCVA), central macular thickness(CMT) by optical coherence tomography(OCT)and intraocular pressure(IOP) by applanation tonometer.Patients underwent eye examinations, including BCVA,CMT, and IOP at pre-injection, 1, 4, 8, 12 and 24 wk after injection. During the follow-up, second injections were performed to eyes which have CMT greater than 400 μm at 12 wk for salvage therapy.RESULTS: BCVA(logarithm of the minimum angle of resolution) at pre-injection, 1, 4, 8, 12 and 24 wk after injection was 0.71 ±0.19, 0.62 ±0.23, 0.63 ±0.12, 0.63 ±0.13,0.63±0.14 and 0.61±0.24 in the IVTA group and 0.68±0.25,0.61 ±0.22, 0.60 ±0.24, 0.62 ±0.25, 0.65 ±0.26 and 0.59 ±0.25 in the IVB group, respectively. CMT(μm) at pre-injection,1, 4, 8, 12 and 24 wk after injection was 544 ±125, 383±96,335 ±87, 323 ±87, 333 ±92, 335 ±61 in the IVTA group and514 ±100, 431 ±86, 428 ±107, 442 ±106, 478 ±112, 430 ±88 in the IVB group respectively. Reduction ratios of mean CMT were 29% at 1wk, 38% at 4wk, 40% at 8wk, 38% at12 wk, and 38% at 24 wk in the IVTA group. Second IVTA injections were performed to the 6 eyes(30%) at 12 wk.Reduction ratios of mean CMT were 16% at 1wk, 17% at4wk, 14% at 8wk, 7% at 12 wk, and 16% at 24 wk in the IVB group. Second IVB injections were performed to the15 eyes(75%) at 12 wk.CONCLUSION: This study showed earlier and more frequent macular edema recurrences in the eyes treated with bevacizumab compared with the ones treated with triamcinolone acetonide. Triamcinolone acetonide was found to provide more efficient and long-standing effect in terms of reducing CMT compared with the bevacizumab.

Long-term effect of triamcinolone acetonide in the treatment of upper lid retraction with thyroid associated ophthalmopathy

AIM： To report the long-term outcomes of a large cohort of upper lid retraction patients treated with subconjunctival triamcinolone acetonide injections.METHODS： This retrospective clinical study was conducted from 2009 to 2016. The documents of 97 patients（126 eyes） were reviewed. The patients were treated with subconjunctival triamcinolone acetonide injections monthly and evaluated pre-and post-treatment by taking measurements of the upper margin reflex distance（MRD1, the distance between the upper-lid margin and the pupil center）, lid aperture, lagophthalmos and proptosis. The patients were divided into the cured group, the improved group and the ineffective group based on the final treatment effectiveness. The improved group and the ineffective group were combined into non-cured group.RESULTS： The follow-up time was 23.45±14.86 mo. Of the patients, 63（64.9%） were assigned to the cured group, 22（22.7%） in the improved group, 12（12.4%） in the ineffective group. Injection times for cured group was 4.66±1.74, and for non-cured group was 5.17±2.08（P≤0.05）. The MRD1 was significantly reduced between baseline and 1 mo after the initiation of treatment in the cured and improved groups（P〈0.001）. The values did not change significantly after 4 mo for the improved group, while they continued to decrease in the cured group. In the ineffective group, the MRD1 did not significantly change after treatment. A statistically significant difference was observed between the baseline and post-treatment values of the mean muscle thickness（2.95±0.99 mm vs 2.04±0.63 mm, P〈0.05） and surface area（27.27±10.5 mm2 vs 18.3±7.04 mm2,P〈0.05） of the levator superioris with magnetic resonance imaging examination. Twelve patients（12.4%） relapsed after treatment and required additional subconjunctival injections. The main side effects included menstrual cycle disturbances（32%） and elevations of intra-ocular pressure（18.6%）. CONCLUSION： A repeated subconjunctival injection of triamcinolone is an effective and relatively safe treatment for upper lid retraction due to thyroid-associated ophthalmopathy. This is related to the anti-inflammation effect of the medicine and the levator thickness can become thinner. Patients must be monitored regularly for recurrences and side effects.

Short-term effects of intravitreal triamcinolone acetonide injection on ocular blood flow evaluated with color Doppler ultrasonography

AIM:To evaluate the changes in ocular blood flow with color Doppler ultrasonography(CDU) after intravitreal triamcinolone acetonide(IVTA) injection.METHODS:A total of 46 patients who underwent IVTA(4 mg/0.1 mL) injection for diabetic macular edema(DME)(n =22), central retinal vein occlusion(CRVO)(n =12) and choroidal neovascular membrane(CNVM)(n =12) were included in the study. Peak systolic velocity(PSV), end diastolic velocity(EDV) and resistivity index(RI) were measured from the ophthalmic artery(OA), the central retinal artery(CRA) and the posterior ciliary artery(PCA)of each patient with CDU before, at the end of the first week and at the end of the first month following IVTA injection.RESULTS:In the DME group, PSV of OA at the first of the first month(mean ±SD)(37.48 ±10.87 cm/s) increased compared to pre-injection value(31.39 ±10.84 cm/s)(P =0.048). There was a statistically significant decrease(P =0.049) in PSV of CRA at the end of the first month(7.97±2.67 cm/s) compared to the pre-injection(9.47±3.37 cm/s).There was not any statistically significant difference onthe other parameters in the DME group. Also, there was not any statistically significant difference on the ocular blood flow values in the CRVO and CNVM groups.CONCLUSION:We observed that 4 mg/0.1 mL IVTA increased PSV of OA and decreased PSV of CRA in DME patients and did not have any effect on ocular blood flow values of CRVO and CNVM patients.

Comparison of intravitreal injection of conbercept and triamcinolone acetonide for macular edema secondary to branch retinal vein occlusion

AIM:To compare the safety and efficacy of the intravitreal injection of conbercept(IVC)and triamcinolone acetonide(IVTA)for macular edema(ME)secondary to branch retinal vein occlusion(BRVO).METHODS:A prospective,randomized clinical study.Patients with ME secondary to BRVO were randomly assigned to either IVC group or IVTA group at a ratio of 2:1 and a 12-month follow-up was performed.The efficacy outcome measures included the mean changes and differences in best corrected visual acuity(BCVA)and the central retinal thickness(CRT).The safety profiles and the mean retreatment intervals were also compared.RESULTS:There was no statistically significant difference of baseline between the two groups(IVC group,n=36;IVTA group,n=17).At 12mof the BCVA letters improved by 27.31±18.36 in the IVC group,and 13.53±11.37 in the IVTA group(P=0.0004).CRT reduction was 253.33±163.69 and 150.24±134.32 pm,respectively(P=0.0034).The mean BCVA in the IVC group was superior to that of the IVTA group for months 6-12(P<0.01).The mean CRT at 9 and 12mo were thinner in the IVC group compared to the IVTA group(P<0.01).The mean retreatment interval in the IVC group was longer than that in the IVTA group(97.40±36.27d vs 68.71±36.38d,P=0.0030).One eye in the IVC group and seven eyes in the IVTA group developed elevated intraocular pressure(IOP;P=0.0012).The proportion of eyes with cataract new-onset or progression were 19.44%in the IVC group and 64.71%in the IVTA group(P=0.0012).CONCLUSION:IVC could maintain or improve BCVA and reduce CRT for a longer time and have longer retreatment interval than IVTA.In addition,patients treated with IVTA are more susceptible to IOP elevation and cataract progression.

Spectrofluorimetric Method for the Determination of Triamcinolone Acetonide

A simple and highly sensitive method for the determination of triamcinolone acetonide in pharmaceutical formulations is presented. The approach is based on the fluorescence of production of triamcinolone acetonide oxidized by concentrated sulfuric acid. The effect of H2SO4, β-cyclodextrin (β-CD), solvent and cetyltrimethylammonium bromide (CTMAB) were discussed. And two analytical systems were established. One is CTMAB system, the linear range is 0–4.6×10?6 mol/L, and the detection limit is 3.59×10?8 mol/L. The other is β-CD and ethanol system, the linear range is 0–2.3×10?6 mol/L and the detection limit is 1.91×10?8 mol/L. The selectivity of analysis, the analytical figures of optimization, and the accuracy of the method are demonstrated with the determination of triamcinolone acetonide in pharmaceutical preparations. Key words triamcinolone acetonide - fluorimetry - CTMAB - β-cyclodextrin - pharmaceutical analysis CLC number O 657.39 Foundation item: Supported by the National Natural Science Foundation of China (20275028)Biography: Pan Zu-ting (1945-), male, Professor, research direction: analytical chemistry.

Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases

BACKGROUND Intravitreal injection has become an efficient approach for delivering drugs at therapeutic levels to the posterior segment in retinal diseases.However,the increased frequency and number of intravitreal injections have raised concerns about their side effects.As manipulation during surgery is relatively simple,details of the procedure are easily overlooked.Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures.We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide(TA)with the hope of providing an insight into this treatment.CASE SUMMARY Case 1 was a 62-year-old woman with macular edema caused by central retinal vein occlusion in her right eye,and Case 2 was a 65-year-old man with macular edema caused by branch retinal vein occlusion in his right eye.In view of the patients’condition and economic constraints,an intravitreal injection of TA was administered.Due to inappropriate manipulation during surgery,the lens was injured.The site of lens injury and clinical manifestations were different in the two cases.Symptomatic treatment and continuous follow-up were carried out.The therapeutic effect following phacoemulsification of the cataract was satisfactory.CONCLUSION Well-defined surgical incision under proper anesthesia,sufficient patient information and proficient anatomical skills of the physician are mandatory to prevent this rare adverse event.Careful and meticulous phacoemulsification of the cataract is suggested.

Treatment of refractory diabetic macular edema with a fluocinolone acetonide implant in vitrectomized and non-vitrectomized eyes

AIM: To report real-life data on the use of an intravitreal fluocinolone acetonide implant in the treatment of refractory diabetic macular edema(DME) in pars plana vitrectomized(PPV) and non-PPV eyes.METHODS: This was a comparative retrospective observational study of 23 eyes with chronic DME. Bestcorrected visual acuity(BCVA) and central macular thickness(CMT) were recorded at baseline, 1, 4 and 12 mo. Descriptive statistics and non-parametric tests were performed to analyze and compare PPV and non-PPV eyes. RESULTS: Seven PPV and 16 non-PPV eyes were included in the study. Median BCVA in the non-PPV group varied from 0.65 logMAR [Interquartile range(IQR): 0.40] at baseline to 0.42 logMAR(IQR: 0.40) at 12 mo. Median CMT varied from 430 μm(IQR: 131.3) at baseline to 317 μm(IQR: 107.5) at 12 mo. Median BCVA in the PPV group varied from 0.60 logMAR(IQR: 0.62) at baseline to 0.74 logMAR(IQR: 0.34) at 12 mo. Median CMT varied from 483 μm(IQR: 146) at baseline to 397 μm(IQR: 132) at 12 mo. Of 0/7 eyes and 1/16 eyes in the PPV and non-PPV eyes respectively had a baseline visual acuity of 6/12 or better(0.3 logMAR). At last follow up, 1/7 and 5/16 eyes in the PPV and non-PPV group respectively achieved a visual acuity of 6/12 or better.CONCLUSION: Visual outcomes are modest following the use of the fluocinolone acetonide implant for chronic DME. The steroid implant is a useful treatment option in the management of refractory DME in vitrectomized and non-vitrectmized eyes.

Ocular hypertension and severe intraocular pressure elevation after posterior subtenon injection of triamcinolone acetonide for various diseases

AIM:To evaluate and compare the incidences of ocular hyper tension and severe intraocular pressure(IOP)elevation after posterior subtenon injection of triamcinolone acetonide(PSTA)for various diseases.METHODS:Totally 179 eyes that had received PSTA for diabetic macular edema(n=108),pseudophakic cystoid macular edema(n=20),branch retinal vein occlusion(n=16),central retinal vein occlusion(CRVO,n=14),choroidal neovascularization(n=14)or noninfectious uveitis(n=7)were retrospectively enrolled.The primary outcomes included ocular hypertension defined as an IOP>21 mm Hg,and severe IOP elevation defined as a rise of 10 mm Hg or more in IOP compared with baseline.Cox regression models were used to analyze the hazard ratios(HRs)among different diseases.RESULTS:After PSTA,the mean IOPs from month 1 to month 6 all significantly increased(P<0.05).Ocular hypertension occurred in 30.7%of eyes(median time:8 wk),and severe IOP elevation occurred in 16.2%of eyes(median time:9 wk).Patients receiving PSTA for CRVO or uveitis had a significantly higher risk for ocular hypertension(HR=3.049,P=0.004 for CRVO;HR=5.464,P=0.019 for uveitis)and severe IOP elevation(HR=2.913,P=0.034 for CRVO;HR=7.650,P=0.009 for uveitis).CONCLUSION:IOP significantly increases within 6 mo after PSTA,with the onset of ocular hypertension happening mostly at 2 to 3 mo.Patients of CRVO or noninfectious uveitis have a higher risk of ocular hypertension or severe IOP elevation after PSTA and should be monitored for IOP more carefully.

Intravitreal triamcinolone acetonide： a ＂real world＂ analysis of visual acuity, pressure and outcomes

Dear Sir,Triamcinolone acetonide（TA）is worldwide available therapeutic agent that is commonly used throughout medicine.TA remains a safe and important ophthalmic therapeutic agent even after the advent of angiogenesis inhibitors[1-2].

Different Dosages of Intravitreal Triamcinolone Acetonide Injections for Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose:.To study the effect of intravitreal injections of triamcinolone acetonide (TA) for the treatment of macular edema secondary to central retinal vein occlusion.(CRVO).in a sample of Chinese patients from Shaanxi province. Methods:.The 50 eyes from 50 patients were separated into three TA treatment groups:.17 patients were given 4 mg/0.1 ml,.19 patients were given 8 mg/0.2 ml,.and 14 patients were given 16 mg/0.4 ml. Patients were followed up for 12 months. Foveal thickness, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured. Results:.Macular edema responded well both anatomically and functionally to the TA injections. After the initial intravitreal injection,.macular edema recurred at 2-4 months in the low-dose group.(4 mg),.at 3-5 months in the medium-dose group (8 mg), and at 6-9 months in the high-dose group (16 mg)..No significant difference in BCVA or in foveal thickness were observed between the first intravitreal injection and the re-injection. There was no increase in IOP after re-injection of 16 mg TA,.if the patient did not have an elevated IOP after the initial intravitreal injection of 4/8 mg TA. Conclusion: A low dosage of TA (4 mg) administered via intravitreal injection might be useful as an initial treatment for macular edema secondary to CRVO..A higher dosage of TA (16mg) can be used if there is no IOP elevation with the initial TA injection.

Safety of intravitreal triamcinolone acetonide:an electrophysiologic and histopathological study in rabbits

AIM:To evaluate the retinal safety of various doses of intravitreal triamcinolone acetonide(TA)in rabbits.METHODS:Thirty New Zealand albino rabbits were divided into five groups(six animals each).In group 1(control group),each animal received a single intravitreal injection of 0.1 mL phosphate buffered saline.In groups2,3,4 and 5,each rabbit received a single intravitreal injection of 4,8,16 and 32mg of TA,respectively.Each dose was contained in 0.1 mL phosphate buffered saline.Clinical ocular examinations were performed before the injection and on the 1st,3rd,10th and 17th postinjection days.A standard dark adapted electroretinogram(ERG)was obtained before injection and on the 3rd,10th and 17th post-injection days.After17d,animals were sacrificed and their eyes prepared for pathological examination.RESULTS:By monitoring ERG as a functional index for the retina,intravitreal injection of 4mg TA showed no significant ERG changes.At doses of 8,16 and 32,hyper-abnormal responses in a-and b-waves of ERG were detected on the 3rd post-injection day.These changes gradually returned back to normal limits after17d.Histopathological examination of the retina of all animals showed no pathological changes.CONCLUSION:High doses of intravitreal TA seemed to have enhancing effects on the retinal function with gradual return to normal limits with no pathological changes detected in examined eyes.

Complications Following Inappropriate Intravitreal Triamcinolone Acetonide Injection

Purpose: Intravitreal Triamcinolone Acetonide (IVTA) is a useful treatment option for various intraocular diseases such as Macular Edema (ME). The treatment can cause several complications, including transient elevation of intraocular pressure and cataract formation. Here, we describe an atypical complication of IVTA. Case: A 60-year-old Japanese man presented with ME associated with central retinal vein occlusion. We performed intravitreal injection of 4 mg of TA. However, the drug spread behind the posterior lens capsule and also flowed into the anterior chamber. Although the amount of TA particles behind the lens capsule decreased over time, these particles persisted for more than 2 months. Conclusion: Although IVTA is an easy and effective treatment for ME, TA is harmful when injected into inappropriate regions of the eye. Accurate IVTA injection is important for effective treatment.

Filter Connected with Three-way Cock in Remove of the Vehicle in Triamcinolone Acetonide

Purpose: To evaluate the clinical effect of 5-μm pore filter connected with three-way cock by removing the vehicle in triamcinolone acetonide(TA) suspension. Methods: Through 5-μm pore filter connected with three-way cock, TA suspension was replaced by intraocular irrigating solution. The new suspension has been applied to 60 cases of diabetic branch retinal vein occlusion,diabetic macular edema and age-related macular degeneration patients through intravitreal injection. It was also been applied to 41 cases of diabetic retinopathy, epimacular membrane, proliferative vitreoretinopathy and idiopathic macular hole patients to assist pas plana vitrectomy (PPV). Whether TA particles can adhere to posterior hyaloid cortex, epiretinal membrane and internal limiting membrane during the surgery have been observed. During follow up, corrected visual acuity and intraocular pressure were recorded. Results: Five μm pore filter connected with three-way cock can remove the vehicle in TA suspension successfully and retain TA particles. When the new suspension was applied to assist PPV, it can adhere to posterior hyaloid cortex, epiretinal membrane, internal limiting membrane and visualized them clearly. In all the 41 cases that underwent PPV surgery, visual acuity of 30 cases increased or remained stable. Intraocular hypertension happened in 4 cases. Two cases of the 41 patients had cataract formation during follow up. In the 60 cases that underwent TA intravitreal injection, 45 cases increased their visual acuity at least 2 lines. Intraocular hypertension happened in 17 cases and 4 patients had cataract formation. None of the 101 patients caught endophthalmitis or other serious complications. Conclusion: Filter connected with three-way cock can remove the vehicle in TA suspension effectively and this procedure can be applied to intravitreal injection or PPV. This manipulation is so simple that it deserves to be popularized for clinical use.

A simple technique for suprachoroidal space injection of triamcinolone acetonide in treatment of macular edema

AIM:To introduce a simple resistance controlled suprachoroidal space(SCS)injection technique using a disposable 30-gauge needle connected to a 1 m L syringe and evaluate the effectiveness and applicability of this technique in the treatment of macular edema.METHODS:A total of 20 patients with various types of macular edema were subjected to a resistance controlled SCS injection of triamcinolone acetonide(TA)with a disposable 30-gauge needle connected to a 1 m L syringe.This technique allows the easy and smooth injection of the TA only once the tip of the needle reached the potential SCS which was indicated by the lower resistance on the plunger.The main outcome measures were anterior segment spectral-domain optical coherence tomography(AS-OCT)measurements post-operation immediately and central subfield thickness(CST),best-corrected visual acuity(BCVA),and intraocular pressure(IOP)measurements at 3mo postoperation.RESULTS:AS-OCT examination showed the expansion of the SCS near the injection site immediately after SCS injection.At three months of follow-up,as compared to the baseline,the mean CST was significantly decreased from 535.0±157.24 to 319.55±127.30μm(P<0.001),the mean BCVA was significantly improved from 1.05±0.41 to 0.73±0.41 log MAR(P<0.001),and the mean IOP was not significantly different,from 15.05±2.54 to 15.85±3.60 mm Hg(P=0.185).Any complication related to the injection procedure including cataract,choroidal and retinal hemorrhage,retinal detachment,or endophthalmitis was not observed in this study.CONCLUSION:The simple and minimally invasive technique of SCS injection of TA with a disposable 30-gauge needle connected to a 1 m L syringe is useful and applicable for macular edema.

Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema

AIM:To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide(TA)injections for treating uveitic macular edema(UME).METHODS:This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6 mo.The main outcome measure was central macular thickness(CMT).The secondary outcome measures included best-corrected visual acuity(BCVA),recurrence rate and intraocular pressure(IOP).RESULTS:In total,65 patients(80 eyes),mainly including idiopathic uveitis in 33 patients(50.77%)and VogtKoyanagi-Harada(VKH)syndrome in 19 patients(29.23%),were enrolled in this study.The mean CMT decreased from 457.6±173.0μm at baseline to 325.9±176.8,302.7±148.2,332.2±177.3 and 270.6±121.6μm at 1-,2-,3-and 6-months postinjection,respectively(all P<0.001).BCVA increased from log MAR 0.5±0.3 at baseline to log MAR 0.4±0.3,0.4±0.3,0.4±0.4 and 0.4±0.3 at the 1-,2-,3-and 6-months postinjection visits,respectively(all P<0.001).Twenty-one(21/80,26.25%)eyes underwent relapse of UME within 6 mo.A total of 20/80(25%)eyes exhibited elevated IOPs,of which 13 eyes were controlled with topical IOP-lowering agents and 7 eyes underwent surgical removal of subconjunctival TA deposit.CONCLUSION:Subconjunctival TA injections appear to be safe and effective for UME.