Abstract
Purpose To determine the characteristics of diabetic macular edema (DME) patients with cotton-wool spots (CWS). Methods We classified 80 treatment-naïve DME patients according to whether or not they had CWS involving macula and then compared the concentrations of interleukin- (IL-) 1β, IL-6, IL-8, IL-10, IL-17, placental growth factor, vascular endothelial growth factor (VEGF), and intercellular adhesion molecule (ICAM)-1 in the aqueous humor between the groups, as well as optical coherence tomography (OCT) findings, baseline characteristics, and intravitreal bevacizumab responsiveness. Results Aqueous levels of ICAM-1 and VEGF in the group with CWS were significantly higher than those in the non-CWS (control) group (p < 0.001 and p = 0.006, respectively). In multiple logistic regression analysis to identify factors associated with CWS, the aqueous ICAM-1 (≥0.36 ng/mL) was significantly associated with CWS (odds ratio = 13.26, p < 0.001). Based on OCT, ellipsoid zone (EZ) disruption distribution was significantly different between the two groups (p = 0.038). Regarding responsiveness to treatment, although there was no significant difference in central subfield thickness between the two groups after treatments, the best-corrected visual acuity was worse in the group with CWS. Conclusions The presence of CWS was accompanied by higher levels of aqueous ICAM-1. Based on OCT, EZ disruption was greater in DME patients with CWS, and their short-term visual prognosis was poorer.
Highlights
Diabetic macular edema (DME) is the major cause of vision impairment in diabetic patients [1, 2]
There was no significant difference in age, sex, diabetic retinopathy (DR) stage distribution, glycated hemoglobin level, best-corrected visual acuity (BCVA), or central subfield thickness (CST) between the two groups
There was no significant difference in CST after three consecutive intravitreal bevacizumab (IVB) injections between the two groups (p = 0:861), the BCVA of the Cotton-wool spots (CWS) group was significantly worse than that of the group without CWS (p = 0:006)
Summary
Diabetic macular edema (DME) is the major cause of vision impairment in diabetic patients [1, 2]. Cytokines, and growth factors are involved in the pathogenesis of DME, which affects the neurovascular system [4]. CWS are the common findings in the nonproliferative stage of diabetic retinopathy (DR), they could be associated with disease progression [6]. Many studies have shown that the aqueous humor of DME patients contains elevated levels of inflammatory cytokines, growth factors, and matrix metalloproteinases, which are associated with the status of the retina [7,8,9]. The individual roles played by these factors in the pathogenesis of DME remain unclear, many studies have sought to determine their mechanisms of action in detail
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