Macular laser photocoagulation with or without intravitreal triamcinolone pretreatment for diabetic macular edema： a result from five randomized controlled trials

AIM：To assess possible benefits of intravitreal triamcinolone acetonide（IVTA）injection as pretreatment for macular laser photocoagulation（MLP）in patients with diabetic macular edema（DME）.·METHODS：Published randomized controlled trials（RCTs）concerning MLP with or without IVTA pretreatment for DME were retrieved from databases CNKI,Medline,EMbase,Web of Science,and the Cochrane Library.A Meta-analysis on eligible studies was conducted using Rev Man 5.0 software.Two investigators independently assessed the quality of the trials and extracted data.Main outcome measures included the change in best-corrected visual acuity（BCVA）,difference in central macular thickness（CMT）and adverse events reporting in particular elevated intraocular pressure within the follow-up period.The results were pooled using weight mean difference（WMD）or odds risk（OR）with their corresponding 95%confidence intervals（CI）.A fixed-or random-effect model was employed depending on the heterogeneity of the inclusion trials.·R ESULTS：Finally,five independent RCTs were identified and used for comparing MLP with IVTA pretreatment（131 eyes）with MLP alone（133 eyes,control group）.The overall study quality was relatively higher according to the modified Jadad scale.The Metaanalysis showed that MLP with IVTA pretreatment significantly reduced CMT at one,three and six months（=0.002,0.0003 and 0.04,respectively）,compared with MLP alone.The IVTA pretreatment group showed statistically significant improvements in BCVA at the one-month follow up as compared with the control group（=0.03）.At three-and six-month follow up,there was a beneficial trend towards improving visual acuity in the IVTA pretreatment group without statistical significance between groups（=0.06 and 0.20,respectively）.The incidence of elevation of intraocular pressure was significantly higher in the IVTA pretreatment group than in the control group（〈0.0001）.No evidence of publication bias was present according to Begg’s test and Egger’s test.There was a low level of heterogeneity in the included studies.·CONCLUSION：This Meta-analysis indicates that MLP with IVTA pretreatment has a better therapeutic effect in terms of CMT reduction and earlier（1mo）visual improvement for patients with DME as compared with MLP alone.Further confirmation with rigorously welldesigned multi-center trials is needed.

Numerical simulation of hydrodynamic environment effects of the reclamation project of Nanhui tidal flat in Yangtze Estuary

The reclamation is the main method in the coast exploitation, and the assessment of the hydrodynamic environment effect of the reclamation project is important for project's site selection and environmental protection. With consideration of the baroclinic water, a 3?D numerical model MIKE3 is applied to simulate Yangtze Estuary's hydrodynamic environment to predict the impacts of the reclamation project of the Nanhui tidal flat. The simulated results of the model agree well with the field data of the tide level, the current speed, the current direction, the temperature, the salinity and the water quality, and it is indicated that after the reclamation project, the high tide level will be lower, while the low tide level will be higher in the South Branch in general. During the spring tide in the dry season, the peak velocity during the ebb tide in the North Channel will be reduced by 13%, while it will be increased by 21% in the South Channel in average. The salinity will be increased in the North Channel, while reduced in the South Passage, besides, the reclamation project will aggravate the saltwater intrusion of the North Branch. The value of N/P will be increased by about 4% in the whole South Branch except for the North Channel, leading to a slight aggravation of the phosphorus restriction effect in the Yangtze Estuary.