Abstract
Purpose: To correlate inflammatory and proangiogenic key cytokines from undiluted vitreous of treatment-naïve central retinal vein occlusion (CRVO) patients with SD-OCT parameters.Methods: Thirty-five patients (age 71.1 years, 24 phakic, 30 nonischemic) underwent intravitreal combination therapy, including a single-site 23-gauge core vitrectomy. Twenty-eight samples from patients with idiopathic, non-uveitis floaterectomy served as controls. Interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF-A) levels were correlated with the visual acuity (logMar), category of CRVO (ischemic or nonischemic) and morphologic parameters, such as central macular thickness-CMT, thickness of neurosensory retina-TNeuro, extent of serous retinal detachment-SRT and disintegrity of the IS/OS and others.Results: The mean IL-6 was 64.7pg/ml (SD ± 115.8), MCP-1 1015.7 ( ± 970.1), and VEGF-A 278.4 ( ± 512.8), which was significantly higher than the control IL-6 6.2 ± 3.4pg/ml (P=0.06), MCP-1 253.2 ± 73.5 (P<0.0000001) and VEGF-A 7.0 ± 4.9 (P<0.0006). All cytokines correlated highly with one another (correlation coefficient r=0.82 for IL-6 and MCP-1; r=0.68 for Il-6 and VEGF-A; r=0.64 for MCP-1 and VEGF-A). IL-6 correlated significantly with CMT, TRT, SRT, dIS/OS, and dELM. MCP-1 correlated significantly with SRT, dIS/OS, and dELM. VEGF-A correlated not with changes in SD-OCT, while it had a trend to be higher in the ischemic versus the nonischemic CRVO group (P=0.09).Conclusions: The inflammatory cytokines were more often correlated with morphologic changes assessed by SD-OCT, whereas VEGF-A did not correlate with CRVO-associated changes in SD-OCT. VEGF inhibition alone may not be sufficient in decreasing the inflammatory response in CRVO therapy.
Highlights
Today, we can assess central retinal vein occlusion (CRVO) patients for changes in central macular thickness (CMT), but we can conduct a detailed analysis of the neurosensory retina layers
Our group has previously described the rationale and the clinical outcome of a combination therapy including a core vitrectomy with the application of anti-vascular endothelial growth factor (VEGF) agents and steroids and we have described the differences of intravitreal cytokines in different RVO categories [14,15]
Patients were included with a CRVO associated significant macular edema (CSME) involving the fovea, but a macular thickness of not more than 1000 μm, which led to a visual acuity of not worse than 2.0 logarithm of the minimum angle of resolution (LogMAR)
Summary
We can assess CRVO patients for changes in central macular thickness (CMT), but we can conduct a detailed analysis of the neurosensory retina layers. 1874-3641/13 reducing the frequent intravitreal reinjections, careful SDOCT analysis allows for flexible anti-VEGF treatment, which has demonstrated significant functional and anatomic changes [5]. Macular edema secondary to central retinal vein occlusion (CRVO) occurs after multifactorial pathophysiologic changes, which affects intraocular cytokine levels [6,7,8]. Cytokines mediate between endothelial cells (EC) and inflammatory cells, which themselves interact with cytokine expression [9, 10]. The prolonged contact of ECs to proinflammatory cytokines might promote more thrombosis on top of the initial venous occlusion. Upregulated vascular endothelial growth factor (VEGF) is thereby a known chemoattractant cytokine for macrophages and leukocytes
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