Therapeutic effect of Ranibizumab combined with Triamcinolone Acetonide on wet age-related macular degeneration and its effect on interleukin

Abstract

Objective: To observe the clinical efficacy of ranibizumab combined with triamcinolone acetonide on wet age-related macular degeneration (AMD) and explore the effect of this method on the levels of IL-1, IL-2, IL-6 and IL-8.

Methods: Prospective study was conducted in this research. 86 cases of patients with wet AMD (102 eyes) admitted in Baogang Hospital of Inner Mongolia from November 2017 to October 2018 were chosen and randomly divided into the ranibizumab group (43 cases, 50 eyes) and the combination group (43 cases, 52 eyes). The ranibizumab group of patients were given intravitreal injection of ranibizumab, and the combination group was additionally given triamcinolone acetonide on the basis of the ranibizumab group. The intraocular pressure values of the two groups before treatment, in 2 weeks, 1 month and 3 months after treatment were compared. The central macular thickness (CMT) and visual acuity of the two groups before treatment as well as in 1 month, 3 months and 6 months after treatment were compared. The levels of IL-1, IL-2, IL-6 and IL-8 in the serum were compared between the two groups before treatment and in 1 month after treatment. The incidences of complications during treatment in the two groups were recorded and compared. The data were analyzed by use of t-test, repeated measures ANOVA and χ² test.

Results: There were no statistically significant differences in intraocular pressure value between the two groups (F_groups = 1.275, p = .496; F_time = 1.810, p = .211; F_interaction = 1.772, p = .335). There were no statistically significant differences in CMT and visual acuity before treatment between the two groups (t = 0.042, p = .967; t = 0.720, p = .473). In one month, three months and six months after treatment, CMT in the combined group was lower than that in the ranibizumab group (t = 2.086, p = .039; t = 3.398, p = .001; t = 2.987, p = .004), and the visual acuity of the combined group was higher than that of the ranibizumab group (t = 3.265, p = .001; t = 2.217, p = .029; t = 2.519, p = .013). CMT showed a decreasing tendency (t_{before treatment} vs. t_{1 month after treatment} = 6.210, 4.218, p < .001; t_{1 month after treatment} vs. t_{3months after treatment} = 16.772, 15.865, p < .001; t_{3 months after treatment} vs. t_{6 months after treatment} = 4.472, 4.848, p < .001) and the visual acuity showed an increasing trend (t_{before treatment} vs. t_{1 month after treatment} = 4.527, 8.395, p < .001; t_{1 month after treatment} vs. t_{3 months after treatment} = 5.369, 5.349, p < .001; t_{3 months after treatment} vs. t_{6 months after treatment} = 3.335, 3.730, p < .001) with the time going by in the two groups. Compared with the indicators before treatment, the levels of IL-1_, IL-6 and IL-8 in the serum in 1 month after treatment were lower in both two groups (t_{combination group} = 10.544, 32.169, 33.156, all p < .001; t_{ranibizumab group} = 8.996, 25.687, 30.754, all p < .001), and these indicators in the combination group were lower than those in the ranibizumab group (t = 2.894, p = .005; t = 5.997, p < .001; t = 3.934, p < .001). Compared with the indicators before treatment, the levels of IL-2 in the serum in 3 months after treatment in the two groups were higher (t = 20.067, 9.091, all < .001), and the indicator in the combination group was higher than that in the ranibizumab group (t = 7.705, p < .001). There were no statistically significant differences in the incidences of bleeding, intraocular foreign body sensation and transient high IOP and the total incidence of complications between the two groups (correction χ² = 0.001, p = .972; correction χ² = 0.221, p = .638; Fisher’s exact test p = .116; correction χ² = 0.004, p = .951).

Conclusions: Intravitreal injection of ranibizumab combined with triamcinolone acetonide can effectively improve the visual function of wet AMD, reduce CMT and the levels of IL-1, IL-6 and IL-8 in the serum, increase the level of IL-2 in the serum and relieve the degree of inflammatory responses.