ObjectiveTo investigate the characteristics, pathogenesis and treatment of steroid-induced diseases. MethodsThe clinical data of one patient with steroid-induced disease diagnosed and treated on October 20th, 2015 were analyzed retrospectively. ResultsThis patient was admitted to the hospital because of "20 years of pain in the left lower limb and 6 months after the recurrence of the muscle atrophy". After previous diagnosis of sciatica, the patient abused hormone therapy (triamcinolone), and had limb muscle weakness, atrophy, proximal limb muscle strength of grade 5-, creatine kinase 53 U/L, and electromyography suggested neurogenic damage of the limbs. We considered steroid myopathy, and required immediate stop of hormone. The patient's symptoms gradually improved. ConclusionSteroid myopathy and the pathogenesis of glucocorticoid abuse are closely related. Regulating the use of hormone, timely detection of complication of steroid myopathy and stopping the use of sugar cortical hormone are the most important measures to avoid the disease and improve the prognosis.
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.
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 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)
ObjectiveTo evaluate the effect of intravitreous injection with triamcinolone acetonide (TA) on macular edema.MothodHaving been examined by ophthalmoscopy, optic coherent tomography (OCT), retinal thickness analyzer (RTA), and fundus fluorescein angiography (FFA), 33 patients (37 eyes) with diffused and (or) cystoid macular edema caused by diabetes and retinal venous occlusion were intravitreously injected with 0.1 ml triamcinolone acetonide (40 mg/ml). During 1-9 month followup period, the visual acuity, intraocular pressure, inflammatory extent, manifestation of lens and fundus were observed, the retinal thickness was examined by OCT and RTA, and vascular leakage were detected by FFA.ResultsMacular thickness was (244.07±118.80), (195.53±57.70), and (181.42±54.79) μm respectively 1, 2, 3 months after treatment; while macular thickness was (724.35±227.41) μm before the treatment. The difference was statistically significant （t =10.72, 12.84, 13.90; P lt;0.001）. The visual acuity was 0.39±0.19, 0.45±0.24, and 0.43±0.21 respectively, comparing with the visual acuity before the treatment (0.20±0.16), the difference was statistically significant （t =4.445, 4.349, 3.474; P lt;0.001, lt;0.001, 0.03）；The result of FFA showed less leakage of fluorescein and proliferative lesion. Four pateints had the ocular pressure ≥25 mm Hg (1 mm Hg=0.133 kPa) in 9 who had ≥20 mm Hg. Recurrence of macular edema was found in 4 eyes of 3 patients 4 and 6 months after the treatment, respectively. No infection or aggravation of lenticular turbidness occurred.ConclusionIntravitreous injection with TA can be used to treat macular edema due to diabetes and retinal venous occlusion, and recurrence of macular edema or increase of intraocular pressure may occur in some patients.(Chin J Ocul Fundus Dis, 2005,21:205-208)
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)
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.
ObjectiveTo seek the evidencebased medicine (EBM) evidences of curative effects of intravitreous injection with triamcinolone acetonide (TA) for macular edema.MethodsAll articles of intravitreous injection TA for macular edema published in English or Chinese were picked up from databases of MEDLINE and CNKI and then evaluated according to EBM standard. The data in accord with research standard were selected by using excluding and including criteria, and classified according to the appraisal standard of clinical therapeutic documents. ResultsIn the selected papers, none in gradeⅠevidence; 1 in gradeⅡevidence; 7 in grade Ⅲ evidence; 24 in grade Ⅳ evidence; and 19 in gradeⅤevidence. Forty-two papers reported that intravitreous injection with TA had significant effect for macular edema within 3 months, and the improvement of visual acuity was recorded in these papers. Regression of macular edema was recorded in 23 papers. Among 20 papers, side-effect was found in 93 eyes (31.41%) and the serious sideeffect in 4 eyes (1.35%).ConclusionsIntravitreous injection with TA has some curative effects for macular edema in short term, but the quality of current study has not been encouraging. There are no grade I document and lack of the study of validity in long term and essentiality and validity of retreatment. The special attention should be payed on the increasing persistency of efficacy and preventing the serious side-effects in the future investigation.(Chin J Ocul Fundus Dis, 2005,21:220-223)
ObjectiveTo observe the expression of inflammatory cytokines in diabetic rats received posterior sub-Tenon capsule injection of triamcinolone acetonide (TA) and pan-retinal photocoagulation. MethodsA total of 48 Brown Norway rats received intraperitoneal injection of streptozotocin to establish the diabetic model. Diabetic rats were randomly divided into experimental group (20 rats), control group (20 rats) and blank group (8 rats). 50 μl TA or saline was injected into the posterior sub-Tenon capsule immediately after the photocoagulation in the experimental group and the control group, respectively. The blank group received no treatment. The mRNA and protein expression level of retinal vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and tumor necrosis fator-α (TNF-α) were measured by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay (ELISA) at 1, 3, 7 days after laser photocoagulation. ResultsThe mRNA and protein expression of VEGF, IL-6, TNF-α of the experimental group and control group were significantly higher than the blank group, the difference was statistically significant (P < 0.05). The mRNA and protein expression of VEGF, IL-6 and TNF-α of the experimental group were significantly lower than that of the control group. On day 1 after laser photocoagulation, the mRNA expression of VEGF was not statistically significant in the experimental group and control group (P > 0.05), the mRNA and protein expression of VEGF, IL-6, TNF-α of the two groups were statistically significant in the remaining observing time (P < 0.05). ConclusionPosterior sub-Tenon capsule injection of TA can effectively reduce retinal photocoagulation induced VEGF, IL-6, TNF-α expression.
ObjectiveTo observe the effects of personalized clinical therapy for polypoidal choroidal vasculopathy (PCV). MethodsEighty-six eyes of 79 patients with PCV were enrolled in this study. There were 60 males (65 eyes) and 19 females (21 eyes). The average age was (64.48±13.15) years old. Best corrected visual acuity (BCVA), slit lamp ophthalmoscopy, fundus photography, optical coherence tomography (OCT), fundus fluorescein angiography (FFA) and/or indocyanine green angiography (ICGA) were measured. The average BCVA was 0.19±0..20. There were three groups in this study including photodynamic therapy (PDT) group (group A, 45 eyes), PDT and intravitreal ranibizumab injection group (group B, 31 eyes), and PDT combined with sub-Tenon's capsule triamcinolone acetonide injection group (group C, 10 eyes). Follow up begun at 1 month after the treatment. 40 eyes in group A were followed up for 1 to 12 months with the average 3.27 months.28 eyes in group B were followed up for 1 to 36 months with the average 6.68 months. 9 eyes in group C were followed up for 1 to 12 months with the average 5.67 months. Patients with recurrent or worsen lesions were followed by FFA or ICGA. Pre- and post-treatment BCVA and retinal thickness of the fovea were comparatively analyzed. ResultsAll eyes (100.0%) in group A, 20 eyes (64.52%) in group B and 9 eyes (90.00%) in group C received treatment only once. The mean BCVA at 1 month after treatment was significantly increased than the pre-treatment BCVA in all 3 groups (t=2.061, 3.262, 3.258; P<0.05), but no significant difference was found between the 3 groups (t=1.345, 0.683, 0.168; P>0.05). Compared to pre-treatment measures, the mean retinal thickness of the fovea was significantly decreased in group A and group B (t=2.239, 4.334; P<0.05), but not changed in group C (t=2.286, P>0.05) at 1 month after treatment. Thirteen eyes in group A were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV and alleviated pigment epithelial detachment (PED), 4 eyes with partial closed PCV, 3 eyes with stable PCV and 3 eyes with worsen PCV. Ten eyes in group B were followed by FFA and (or) ICGA, which showed that there were 3 eyes with complete closed PCV, 3 eyes with partial closed PCV, 4 eyes with recurrence PCV. Five eyes in group C were followed by FFA and (or) ICGA, which showed that there were 4 eyes with complete closed PCV, 1 eyes with recurrence PCV. ConclusionAll 3 therapy strategies can stop or reduce PCV leakage and improve the visual acuity in some degree.