Early effects of intravitreal triamcinolone acetonide on inflammation and proliferation in human choroidal neovascularization.
OBJECTIVE
To evaluate the early effects of triamcinolone acetonide (TA) on inflammation, proliferation, and vascular endothelial growth factor (VEGF) in human choroidal neovascularization (CNV).


METHODS
Retrospective review of an interventional case series of 29 patients who underwent macular translocation. Fourteen CNV membranes without previous therapy (control CNV group) and 4 CNV membranes excised 3 days after photodynamic therapy (PDT CNV group) comprised the control groups. Eleven patients were treated with intravitreal TA (TA CNV group; n = 5) or PDT and TA combined (PDT+TA CNV group; n = 6) 3 to 9 days preoperatively. The CNV membranes were stained for cytokeratin 18, CD34, VEGF, intercellular adhesion molecule-1 (ICAM-1), E-selectin, CD68, CD45, Ki-67, and Thy-1.


RESULTS
Treatment with TA and PDT+TA resulted in increased immunostaining of ICAM-1 in endothelial cells and the stroma and a higher percentage of Thy-1 expression than controls. The density of macrophages was significantly increased in PDT+TA CNV membranes. Leukocyte density and proliferative activity were lower in TA and PDT+TA CNV membranes. The total VEGF score was significantly increased in TA and PDT+TA CNV membranes compared with the control CNV membranes. Evidence of VEGF in the retinal pigment epithelium of PDT+TA CNV membranes was stronger than in control CNV membranes.


CONCLUSIONS
Triamcinolone acetonide has no inhibitory effect on macrophage infiltration or ICAM-1, Thy-1, or VEGF expression in CNV membranes in the early term. The clinical benefits of TA are probably not based on pure antiinflammatory or VEGF-suppressing mechanisms.
Tatar
Olcay
O
University Eye Hospital at the Centre for Ophthalmology of the Eberhard-Karls University, Tuebingen, Germany.
Adam
Annemarie
A
Shinoda
Kei
K
Kaiserling
Edwin
E
Boeyden
Vicky
V
Claes
Carl
C
Eckardt
Claus
C
Eckert
Tillmann
T
Pertile
Grazia
G
Scharioth
Gabor B
GB
Yoeruek
Efdal
E
Szurman
Peter
P
Bartz-Schmidt
Karl Ulrich
KU
Grisanti
Salvatore
S
D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D019040:E-Selectin / Q000378:metabolism; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007249:Inflammation / Q000188:drug therapy / Q000378:metabolism; D007267:Injections; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D017075:Laser Coagulation; D017493:Leukocyte Common Antigens / Q000378:metabolism; D007958:Leukocyte Count; D007962:Leukocytes / Q000473:pathology*; D008213:Lymphocyte Activation; D008264:Macrophages / Q000473:pathology*; D008268:Macular Degeneration / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D012160:Retina / Q000637:transplantation; D012189:Retrospective Studies; D018800:Thy-1 Antigens / Q000378:metabolism; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*; D014822:Vitreous Body; D000097382:CD68 Molecule
D000893:Anti-Inflammatory Agents; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D019040:E-Selectin; D018799:Intercellular Adhesion Molecule-1; D017493:Leukocyte Common Antigens; D018800:Thy-1 Antigens; D014222:Triamcinolone Acetonide; D042461:Vascular Endothelial Growth Factor A; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C467484:VEGFA protein, human; C516769:PTPRC protein, human