title: Therapeutic effect of intravitreal injection of triamcinolone in the treatment of endothelial graft rejection:  a pilot study.
abstract: OBJECTIVE
  To investigate the efficacy of intravitreal triamcinolone acetonide (IVTA) injection in the treatment of endothelial graft rejection and the expression of T-helper type 1 (Th-1) chemokines in the aqueous humor.
  
  
  METHODS
  Eleven patients (11 eyes) with acute endothelial graft rejection underwent IVTA (4 mg/0.1 mL) injection in addition to conventional treatment, including systemic and topical steroids and cyclosporine A (group A); 13 patients (13 eyes) received conventional treatment only (group B). Clinical characteristics were analyzed. In group A, Th-1 chemokines (CXCL-9, -10, and -11) in aqueous humor were measured by enzyme-linked immunosorbent assay and CXCR3(+) cells were counted by flow cytometry before treatment and at the period of improvement.
  
  
  RESULTS
  There were no significant differences in visual acuity, intraocular pressure, and recurrence rate between the 2 groups. The mean time to improvement was 9.1 ± 3.9 days in group A and 15.4 ± 5.5 days in group B (P = 0.04). The concentrations of CXCL-9, -10, and -11 were 562.7 ± 109.4, 30293.1 ± 12537.1, and 228.3 ± 80.8 pg/mL before treatment and 6.7 ± 6.8 (P < 0.01), 207.5 ± 209.8 (P < 0.01), and 18.9 ± 19.5 (P < 0.01) pg/mL after treatment, respectively. The CXCL-10 level correlated with the time to improvement of graft rejection (P = 0.02). Flow cytometry demonstrated a significantly decreased number of CXCR3(+) and CXCR3(+)CD4(+) cells in the aqueous humor after treatment.
  
  
  CONCLUSIONS
  IVTA injection was effective in reducing the time to improvement of endothelial graft rejection. Increased expression of CXCL-9, -10, and -11, and their receptors in the aqueous humor of patients with endothelial graft rejection decreased after treatment.
authors.affiliation: Department of Ophthalmology and Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, South Korea.
authors.forename: In-Cheon
authors.initials: IC
authors.lastname: You
authors.forename: Kyung-Chul
authors.initials: KC
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D001082:Aqueous Humor / Q000378:metabolism; D018925:Chemokines / Q000378:metabolism; D003316:Corneal Diseases / Q000601:surgery; D004728:Endothelium, Corneal / Q000187:drug effects* / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D058449:Intravitreal Injections; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D018417:Th1 Cells / Q000276:immunology; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D018925:Chemokines; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide