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.

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.

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.

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.

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.

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].

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.

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.

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.

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.

Therapeutic effect of Ranibizumab combined with Triamcinolone Acetonide on wet age-related macular degeneration and its effect on interleukin

Objective:To observe the clinical efficacy of ranibizumab combined with triamcinolone acetonide on wet age-related macular degeneration(AMD)and explore the effect of this method on the levels of IL-1β,IL-2,IL-6 and IL-8.Methods:Prospective study was conducted in this research.86 cases of patients with wet AMD(102 eyes)admitted in Baogang Hospital of Inner Mongolia from November 2017 to October 2018 were chosen and randomly divided into the ranibizumab group(43 cases,50 eyes)and the combination group(43 cases,52 eyes).The ranibizumab group of patients were given intravitreal injection of ranibizumab,and the combination group was additionally given triamcinolone acetonide on the basis of the ranibizumab group.The intraocular pressure values of the two groups before treatment,in 2 weeks,1 month and 3 months after treatment were compared.The central macular thickness(CMT)and visual acuity of the two groups before treatment as well as in 1 month,3 months and 6 months after treatment were compared.The levels of IL-1β,IL-2,IL-6 and IL-8 in the serum were compared between the two groups before treatment and in 1 month after treatment.The incidences of complications during treatment in the two groups were recorded and compared.The data were analyzed by use of t-test,repeated measures ANOVA andχ^(2) test.Results:There were no statistically significant differences in intraocular pressure value between the two groups(Fgroups=1.275,p=.496;Ftime=1.810,p=.211;Finteraction=1.772,p=.335).There were no statistically significant differences in CMT and visual acuity before treatment between the two groups(t=0.042,p=.967;t=0.720,p=.473).In one month,three months and six months after treatment,CMT in the combined group was lower than that in the ranibizumab group(t=2.086,p=.039;t=3.398,p=.001;t=2.987,p=.004),and the visual acuity of the combined group was higher than that of the ranibizumab group(t=3.265,p=.001;t=2.217,p=.029;t=2.519,p=.013).CMT showed a decreasing tendency(tbefore treatment vs.t1 month after treatment=6.210,4.218,p<.001;t1 month after treatment vs.t3months after treatment=16.772,15.865,p<.001;t3 months after treatment vs.t6 months after treatment=4.472,4.848,p<.001)and the visual acuity showed an increasing trend(tbefore treatment vs.t1 month after treatment=4.527,8.395,p<.001;t1 month after treatment vs.t3 months after treatment=5.369,5.349,p<.001;t3 months after treatment vs.t6 months after treatment=3.335,3.730,p<.001)with the time going by in the two groups.Compared with the indicators before treatment,the levels of IL-1β,IL-6 and IL-8 in the serum in 1 month after treatment were lower in both two groups(tcombination group=10.544,32.169,33.156,all p<.001;tranibizumab group=8.996,25.687,30.754,all p<.001),and these indicators in the combination group were lower than those in the ranibizumab group(t=2.894,p=.005;t=5.997,p<.001;t=3.934,p<.001).Compared with the indicators before treatment,the levels of IL-2 in the serum in 3 months after treatment in the two groups were higher(t=20.067,9.091,all p<.001),and the indicator in the combination group was higher than that in the ranibizumab group(t=7.705,p<.001).There were no statistically significant differences in the incidences of bleeding,intraocular foreign body sensation and transient high IOP and the total incidence of complications between the two groups(correctionχ^(2)=0.001,p=.972;correctionχ^(2)=0.221,p=.638;Fisher’s exact test p=.116;correctionχ^(2)=0.004,p=.951).Conclusions:Intravitreal injection of ranibizumab combined with triamcinolone acetonide can effectively improve the visual function of wet AMD,reduce CMT and the levels of IL-1β,IL-6 and IL-8 in the serum,increase the level of IL-2 in the serum and relieve the degree of inflammatory responses.

The erapeutic effect of triamcinolone acetonide with pingyangmycin on lymphatic malformations in oral and maxillofacial regions

Objective To investigate therapeutic effect of tri- amcinolone acetonide and pingyangmycin on lymphatic malformations in oral and maxillofacial regions. Methods 29 patients with lymphatic malformations in oral and maxillofacial regions were divided into two groups to re-

Intravitreal bevacizumab with or without triamcinolone acetonide for diabetic macular edema： a meta-analysis of randomized controlled trials

Background Intravitreal anti-vascular endothelial growth factor （anti-VEGF） drugs and corticosteroids are being widely used to treat diabetic macular edema （DME）. The purpose of this study was to evaluate further the efficacy and safety of intravitreal bevacizumab （IVB） alone in comparison with intravitreal bevacizumab combined with triamcinolone acetonide （IVB/IVT） in the treatment of DME. Methods Pertinent publications were identified through CNKI, PubMed, Medline, EMBASE, and the Cochrane Controlled Trials Register up to November 30, 2013. Two investigators independently assessed the quality of the trials, and changes in central macular thickness （CMT） and best-corrected visual acuity （BCVA） were extracted at 6 weeks and 3, 6, 12, and 24 months after the initial treatment. A meta-analysis was carried out to compare the results between the groups receiving IVB and IVB/IVT using the software RevMan 5.0. Results A total of six randomized controlled trials （RCTs） were identified and included. The meta-analysis revealed that a significant reduction of the CMT was observed at 3 months after the initial treatment in the IVB/IVT group compared to the IVB group （P=-0.001）. Also, changes in CMT at 6 weeks and 6, 12, and 24 months did not vary significantly between the IVB and IVB/IVT groups （P=0.53, 0.76, 0.34, and 0.09, respectively）. Similarly, changes in BCVA at 6 weeks and 3, 6, 12, and 24 months also did not vary significantly between the two groups （P=-0.66, 0.98, 0.81, 0.07, and 0.80, respectively）. The results were robust to sensitivity analyses. However, the rate of intraocular pressure （IOP） rise after intravitreal injections varied significantly between the IVB and IVB/IV＇r groups （P 〈0.01）. A publication bias was not detected by funnel plots, the Egger method, or the Begg method. Conclusions Results of this meta-analysis showed that the treatments with IVB alone and combined IVB/IVT were similarly effective in improving the visual acuity, and, to some degree; combined IVB/IVT appeared to offer a marginal advantage over IVB in decreasing CMT in patients with DME. However, the addition of IV＇I- resulted in intraocular pressure rise in some treated patients.

Intravitreal bevacizumab versus triamcinolone acetonide for macular edema due to branch retinal vein occlusion： a matched study

Background Branch retinal vein occlusion （BRVO） is a common retinal vascular disorder of the elderly and both intravitreal triamcinolone acetonide （TA） and intravitreal bevacizumab were reported to be effective. The purpose of this study was to compare intravitreal bevacizumab with intravitreal TA for the treatment of macular edema resulting from BRVO. Methods The retrospectively comparative interventional study included a bevacizumab group of 34 BRVO patients （1.25 mg bevacizumab） and a TA group of 34 BRVO patients （4.0 mg TA）, and the two groups were matched by baseline best corrected visual acuity （BCVA）. Examinations were designed to be carried out at 1 day, 3 days, 1 month, 2 months, 3 months, 6 months and 1 year after each injection. The mean follow-up was （148.43±130.56） days. Main outcome parameters were BCVA and morphometric measurements of the macula obtained by optical coherence tomography. Results In all follow-ups, the mean changes of BCVA （LogMAR） between two groups were not significantly different （P 〉0.10）. Similarly, the rates of patients who got BCVA improvement ≥2 lines or lost BCVA ≥2 lines were not significantly different, either （P 〉0.10）. In both groups, compared with baseline, the mean central macular thickness （CMT） got reduction from 4 weeks to 1 year after initial injection, however, which lost statistical significance at 6-month follow-up in TA group （P=0.25） and lost significance at 3-month and 6-month follow-up in bevacizumab group （P=0.07, 0.21）. The mean CMT between two groups differed at 3-month follow-up （P 〈0.01）, while almost kept parallel in other follow-ups （all P 〉0.40）. In TA group, retinal pigment epithelium tear occurred in 1 eye at 8 weeks after initial injection and 12 eyes （35.3%） got intraocular pressure 〉21 mmHg. In bevacizumab group, no severe complications were observed. Conclusion For BRVO, intravitreal bevacizumab versus intravitreal TA causes a similar increase in visual acuity and reduction of macular edema （except 3-month follow-up） with minor complications during 1 year.

Intravitreal bevacizumab combined with/without triamcinolone acetonide in single injection for treatment of diabetic macular edema

Background Diabetic macular edema （DME） is a common manifestation of diabetic retinopathy （DR） that forms the main cause of central visual impairment. This study aimed to compare the efficacy and safety of a single intravitreal injection of bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with diabetic macular edema （DME）.Methods A total of 40 eyes in 40 Chinese patients （22 male and 18 female） diagnosed with diabetic macular edema were enrolled in this prospective, randomized, consecutive study. Among them, 21 patients in group 1 were treated with intravitreal injection of bevacizumab （1.25 mg/0.05 ml）, and the other 19 patients in group 2 accepted intravitreal bavacizumab （1.25 mg/0.05 ml） combined with triamcinolone acetonide （2 mg/0.05 ml）. All patients were examined at baseline and followed up at 4, 6 and 12 weeks after the injection. Changes in mean best correct visual acuity （BCVA）using ETDRS chart, central retina thickness （CRT） measured by optical coherence tomography （OCT）, and intraocular pressure （IOP） were focused on.Results In group 1, mean BCVA improved from （41.76±15.59） letters （baseline） to （56.24±18.56）letters, （52.5712.31）letters and （48.41±17.90） letters at 4, 6 and 12 weeks post-injection, respectively （P=0.004, P=0.011 and P=0.026,respectively）. Mean CRT decreased from （525.76±184.10）μm（baseline） to （270.33±202.67） μm, （303.12±168.43） μm and（402.26±196.21）μm, respectively （P=0.009, P=0.016 and P=0.030, respectively）. In group 2, mean BCVA improved from （39.89±12.27） letters （baseline） to （55.31±19.27） letters, （51.25±13.48） letters and （46.97±16.23） letters at 4, 6 and 12 weeks after injection, respectively （P=0.003, P=0.010 and P=0.027, respectively）. Mean CRT decreased from （554.50±169.05）μm（baseline） to （292.76±196.05）μm, （323.46±164.05） μm and （426.38±169.05） μm, respectively （P=0.009, P=0.014 and P=0.028, respectively）. However, there was no significant difference between these two groups with regard to mean BCVA （F=1.602, P=0.216） and CRT （F=0.412, P=0.526）. At 12 weeks after the injection, 11 of the patients in group 1 and nine patients in group 2 appeared recurrent macular edema and needed repeat injections. There was one patient in group 2 appeared transient intraocular pressure increases.Conclusions Intravitreal injection of bevacizumab combined with/without triamcinolone acetonide had a beneficial effect on DME. However, the significant effect was not permanent. Our results showed that no significant differences were detected between intravitreal bevacizumab combined with/without triamcinolone acetonide for the eyes with diabetic macular edema in Chinese patients.

Effects of Low-dose Triamcinolone Acetonide on Rat Retinal Progenitor Cells under Hypoxia Condition

Background： Retinal degenerative diseases are the leading causes of blindness in developed world. Retinal progenitor cells （RPCs） play a key role in retina restoration. Triamcinolone acetonide （TA） is widely used for the treatment of retinal degenerative diseases. In this study, we investigated the role of TA on RPCs in hypoxia condition. Methods： RPCs were primary cultured and identified by immunofluorescence staining. Cells were cultured under normoxia, hypoxia 6 h, and hypoxia 6 h with TA treatment conditions, For the TA treatment groups, after being cultured under hypoxia condition for 6 h, RPCs were treated with different concentrations of TA for 48-72 h. Cell viability was measured by cell counting kit-8 （CCK-8） assay. Cell cycle was detected by flow cytometry. Western blotting was employed to examine the expression ofcyclin D 1, Akt, p-Akt, nuclear factor （N F）-KB p65, and caspase-3. Results： CCK-8 assays indicated that the viability of RPCs treated with 0.01 mg/ml TA in hypoxia group was improved after 48 h, comparing with control group （P 〈 0.05）. After 72 h, the cell viability was enhanced in both 0.0l mg/ml and 0.02 mg/ml TA groups compared with control group （all P 〈 0.05）. Flow cytometry revealed that there were more cells in S-phase in hypoxia 6 h group than in normoxia control group （P 〈 0.05）. RPCs in S and G2/M phases decreased in groups given TA, comparing with other groups （all P 〈 0.05）. There was no significant difference in the total Akt protein expression among different groups, whereas upregulation of p-Akt and NF-KB p65 protein expression and downregulation of caspase-3 and cyclin DI protein expression were observed in 0.01 mg/ml TA group, comparing with hypoxia 6 h group and control group （all P 〈 0.05）. Conclusion： Low-dose TA has anti-apoptosis effect on RPCs while it has no stimulatory effect on cell proliferation.