Intravitreal Triamcinolone Acetonide in the Treatment of Ophthalmic Inflammatory Diseases with Macular Edema: A Meta-Analysis Study

Bucolo, Claudio; Grosso, Giuseppe; Drago, Valentina; Gagliano, Caterina

doi:10.1089/jop.2014.0094

Cited by 8 publications

(5 citation statements)

References 48 publications

(47 reference statements)

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“…There is in general, a concern over a higher incidence of IOP elevation following intravitreal use of triamcinolone acetonide. 30 The implant is considered safer than other corticosteroids for ocular use. 21 Also, a retrospective comparative case series 31 found the dexamethasone implant superior to sub-tenon corticosteroids in the treatment of inflammatory cystoid macular edema, including CME, due to Irvine-Gass syndrome both in terms of efficacy and safety.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine–Gass syndrome: a prospective case series

Sudhalkar

Chhablani

Vasavada

et al. 2016

Eye

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Section: Discussionmentioning

confidence: 99%

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine–Gass syndrome: a prospective case series

Sudhalkar

Chhablani

Vasavada

et al. 2016

Eye

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“…Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents (bevacizumab, ranibizumab, aflibercept) are the standard of care for treatment of diabetic macular edema (DME) ( Hatamnejad et al, 2024 ), but recently also brolucizumab and faricimab have been approved for DME treatment ( Montesel et al, 2021 ; Wong et al, 2023 ). In some cases, also intravitreal steroids, such as dexamethasone and triamcinolone acetonide are indicated to treat DME ( Bucolo et al, 2015 ; Bucolo et al, 2018 ). Besides these mentioned pharmacological treatments, several unmet medical needs affect diabetic retinopathy management: burden of care due to high cost and invasive intravitreal treatments, poor adherence, and 40%–50% of cases refractory to current approved pharmacological interventions ( Hatamnejad et al, 2024 ; Mandava et al, 2024 ).…”

Section: Introductionmentioning

confidence: 99%

Anti-angiogenic and antioxidant effects of axitinib in human retinal endothelial cells: implications in diabetic retinopathy

Lazzara,

Conti,

Sasmal

et al. 2024

Front. Pharmacol.

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Diabetic retinopathy is a secondary microvascular complication of diabetes mellitus. This disease progresses from two stages, non-proliferative and proliferative diabetic retinopathy, the latter characterized by retinal abnormal angiogenesis. Pharmacological management of retinal angiogenesis employs expensive and invasive intravitreal injections of biologic drugs (anti-vascular endothelial growth factor agents). To search small molecules able to act as anti-angiogenic agents, we focused our study on axitinib, which is a tyrosine kinase inhibitor and represents the second line treatment for renal cell carcinoma. Axitinib is an inhibitor of vascular endothelial growth factor receptors, and among the others tyrosine kinase inhibitors (sunitinib and sorafenib) is the most selective towards vascular endothelial growth factor receptors 1 and 2. Besides the well-known anti-angiogenic and immune-modulatory functions, we hereby explored the polypharmacological profile of axitinib, through a bioinformatic/molecular modeling approach and in vitro models of diabetic retinopathy. We showed the anti-angiogenic activity of axitinib in two different in vitro models of diabetic retinopathy, by challenging retinal endothelial cells with high glucose concentration (fluctuating and non-fluctuating). We found that axitinib, along with inhibition of vascular endothelial growth factor receptors 1 (1.82 ± 0.10; 0.54 ± 0.13, phosphorylated protein levels in fluctuating high glucose vs. axitinib 1 µM, respectively) and vascular endothelial growth factor receptors 2 (2.38 ± 0.21; 0.98 ± 0.20, phosphorylated protein levels in fluctuating high glucose vs. axitinib 1 µM, respectively), was able to significantly reduce (p < 0.05) the expression of Nrf2 (1.43 ± 0.04; 0.85 ± 0.01, protein levels in fluctuating high glucose vs. axitinib 1 µM, respectively) in retinal endothelial cells exposed to high glucose, through predicted Keap1 interaction and activation of melanocortin receptor 1. Furthermore, axitinib treatment significantly (p < 0.05) decreased reactive oxygen species production (0.90 ± 0.10; 0.44 ± 0.06, fluorescence units in high glucose vs. axitinib 1 µM, respectively) and inhibited ERK pathway (1.64 ± 0.09; 0.73 ± 0.06, phosphorylated protein levels in fluctuating high glucose vs. axitinib 1 µM, respectively) in HRECs exposed to high glucose. The obtained results about the emerging polypharmacological profile support the hypothesis that axitinib could be a valid candidate to handle diabetic retinopathy, with ancillary mechanisms of action.

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“…Triamcinolone is a corticosteroid that is five times more potent than the natural compound cortisol, making it an extremely potent anti-inflammatory agent,9 and it is approved by the United States Food and Drug Administration for the management of chronic ocular inflammatory conditions, such as uveitis 10. Additionally, triamcinolone has been reported previously to prevent postoperative complications after pediatric lensectomy,11 making it an appropriate choice to investigate in this rabbit animal model.…”

Section: Introductionmentioning

confidence: 99%

Use of a Juvenile Rabbit Animal Model to Evaluate Therapeutic Interventions for Postoperative Inflammation and Fibrin Formation After Lensectomy

Bogaard

Young

Movahedan

et al. 2019

Trans. Vis. Sci. Tech.

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PurposeWe used the juvenile rabbit as a model for investigating therapeutic interventions for postoperative inflammation and fibrin formation following intraocular lens (IOL) insertion for management of pediatric cataracts.MethodsTwelve 6- to 7-week-old, 600 to 900 g rabbits underwent bilateral clear-cornea lensectomy via irrigation and aspiration with IOL insertion. Following wound closure, enoxaparin 8 mg (n = 6 eyes), preservative-free triamcinolone 0.5 mg (n = 6), 8 mg enoxaparin plus 0.5 mg triamcinolone (n = 6), or balanced salt solution (n = 6) was injected into the anterior chamber. Slit-lamp examinations and optical coherence tomography (OCT) scans were performed postoperatively on days 3 through 7, and 14 to characterize levels of inflammation and fibrin. Using 17 additional rabbits, enzyme-linked immunosorbent assays (ELISAs) with 100 μL of aqueous humor were performed to quantify the amount of fibrinogen and fibrin preoperatively and on postoperative day 3. Immunohistochemistry was performed to confirm the presence of fibrin.ResultsEnoxaparin alone and combined with triamcinolone reduced the amount of fibrin present in the anterior chamber compared to untreated eyes, which corresponded to an increase in OCT signal strength. Despite the clear visual axis shown in clinical images, the combination treatment group had the highest levels of soluble fibrin when assessed by ELISA. Immunohistochemistry confirmed the presence of insoluble fibrin seen clinically.ConclusionsA combination of enoxaparin and triamcinolone appears to provide the most therapeutic benefit by reducing fibrin formation and postoperative inflammation.Translational RelevanceThe juvenile rabbit is an excellent model to investigate inflammation and fibrin formation following lensectomy with IOL insertion and possibly any intraocular surgery in children.

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Intravitreal Triamcinolone Acetonide in the Treatment of Ophthalmic Inflammatory Diseases with Macular Edema: A Meta-Analysis Study

Cited by 8 publications

References 48 publications

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine–Gass syndrome: a prospective case series

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine–Gass syndrome: a prospective case series

Anti-angiogenic and antioxidant effects of axitinib in human retinal endothelial cells: implications in diabetic retinopathy

Use of a Juvenile Rabbit Animal Model to Evaluate Therapeutic Interventions for Postoperative Inflammation and Fibrin Formation After Lensectomy

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