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Clinical science
Early use of intravitreal triamcinolone to inhibit traumatic proliferative vitreoretinopathy: a randomised clinical trial
  1. Haixia Guo1,
  2. Jinguo Yu1,
  3. Tiangeng He1,
  4. Song Chen1,
  5. Zhuoyu Sun2,
  6. Jingkai Zhang1,
  7. Zhiyong Sun1,
  8. Wenhui Yang1,
  9. Baoqun Yao1,
  10. Xueli Yang3,
  11. Yuanyuan Liu1,
  12. Mingxue Zhang1,
  13. Yu Meng4,
  14. Likun Yang1,
  15. Hua Yan1,5,6,7
  1. 1Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
  2. 2Department of Epidemiology and Statistics, Tianjin Medical University, Tianjin, China
  3. 3The First Affiliated Hospital of Dali University, Dali University, Dali, Yunnan, China
  4. 4Airport Hospital, Tianjin Medical University General Hospital, Tianjin, China
  5. 5Tianjin Key Laboratory of Ocular Trauma, TIanjin Medical university, Tianjin, China
  6. 6Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
  7. 7School of Medicine, Nankai University, Tianjin, China
  1. Correspondence to Professor Hua Yan, Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China; zyyyanhua{at}tmu.edu.cn

Abstract

Aims To evaluate the efficacy and safety of intravitreal triamcinolone acetonide (TA) injection at the end of emergency surgery for open globe injury (OGI) to suppress traumatic proliferative vitreoretinopathy (TPVR).

Methods A single-centre, participant-masked, prospective, randomised controlled clinical trial. A total of 68 globe rupture patients with zone III were randomised to the control group (n=34) or the TA group (n=34) in 1:1 allocation ratio. Patients were treated with 0.1 mL TA in the TA group and 0.1 mL balanced salt solution in the control group at the end of emergency surgery. The primary outcome was the assessment of TPVR during vitrectomy 10±3 days later. Secondary outcomes included visual acuity (VA), retinal attachment rate, macular attachment rate, proliferative vitreoretinopathy (PVR) recurrent rate, side effects 6 months after vitrectomy.

Results During vitrectomy, the TPVR grade of the control group was significantly more severe than the TA group (p=0.028). The TPVR score was significantly better in the TA group (9.30±0.82) than in the control group (6.44±1.06) (p=0.036). The final VA improved in 23 eyes (92%) in the TA group and in 14 eyes (63.64%) in the control group (p=0.008). The retinal attachment rates were 88% and 63.64% in the TA and control group, respectively (p=0.049). The two groups showed no significant difference in macular repositioning and PVR recurrent rate (p=0.215, 0.191). Temporary intraocular pressure elevation occurred in one eye in the TA group after emergency surgery.

Conclusions Early intravitreal TA injection for OGI effectively reduces TPVR, increases surgical success and improves visual prognosis.

  • Trauma
  • Wound healing
  • Retina
  • Inflammation
  • Eye (Globe)

Data availability statement

Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/bjo-2023-324318

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    Data availability statement

    Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors HG is the major contributor in finishing this clinical trial, collecting and analysing the data, and writing the manuscript. HY is the corresponding author responsible for the integrity and validity of the manuscript. HG, JY, TH, SC, JZ, ZS, WY, BY, XY, YL, MZ, YM and LY collected and reviewed the patient data. ZS, HG and XY analysed the data. HY is guarantor.

    • Funding This work was supported by National Key Research and Development Program of China (Grant Number 2021YFC2401404), National Natural Science Foundation of China (Grant Numbers 82330031).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.